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Kwon CY, Lee HG, Jeong H, Kim SC, Jang S. Safety of herbal decoctions: A scoping review of clinical studies in South Korea focusing on liver and kidney functions. J Ethnopharmacol 2024; 325:117664. [PMID: 38199337 DOI: 10.1016/j.jep.2023.117664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/29/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Approximately 27% of individuals seeking Korean medicine (KM) services in South Korea are prescribed herbal decoctions. The South Korean government has considered the validity of providing National Health Insurance coverage for herbal decoctions. Therefore, it is important to investigate their safety. AIM OF THE STUDY To investigate the safety of herbal decoctions commonly prescribed by KM doctors and to assess their effects on liver and kidney function by comprehensively analyzing Korean clinical studies in a scoping review. MATERIALS AND METHODS The Arksey and O'Malley framework and modified methods were applied in this scoping review. A comprehensive search of seven electronic health databases was conducted, and relevant clinical studies published between 2000 and 2022 were identified. Subsequently, only clinical studies reporting the results of liver and/or renal function tests in patient prescribed herbal decoctions by KM doctors were included. The characteristics of the included clinical studies and the reported proportion of each liver and/or renal function indicator were analyzed. Meta-analyses of the effects of herbal decoction on liver and/or renal function reported in prospective cohort studies were also performed. RESULTS Fifty-nine clinical studies were included in this review. The proportion of prospective cohort studies markedly decreased in the 2010s compared to the 2000s, while there was no noticeable change in the number of relevant clinical studies. Herbal decoctions were prescribed for less than one month in most included studies. Abnormal changes in liver or renal function indicators were identified in a small number of studies (3.70% and 7.69%, respectively). In a meta-analysis of 15 prospective cohort studies, no statistically significant changes in four liver function indices and two renal function indices were observed before and after the prescription of herbal decoctions. CONCLUSIONS Qualitative and quantitative analyses demonstrated favorable safety profiles for herbal decoctions. This scoping review includes the gaps noted between clinical application and research regarding the safety profiles of herbal decoctions. These findings could be used as evidence to support the inclusion of herbal decoction prescriptions in the National Health Insurance coverage in South Korea.
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Affiliation(s)
- Chan-Young Kwon
- Department of Oriental Neuropsychiatry, College of Korean Medicine, Dongeui University, Busan 47227, Republic of Korea
| | - Han-Gyul Lee
- Kyung Hee University Medical Center, Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Hyein Jeong
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Sang Chan Kim
- College of Korean Medicine, Daegu Haany University & Research Center for Herbal Convergence on Liver Disease, Republic of Korea
| | - Soobin Jang
- College of Korean Medicine, Daegu Haany University & Research Center for Herbal Convergence on Liver Disease, Republic of Korea.
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Attisso E, Guenette L, Dionne CE, Kröger E, Dialahy I, Tessier S, Jean S. New opioid prescription claims and their clinical indications: results from health administrative data in Quebec, Canada, over 14 years. BMJ Open 2024; 14:e077664. [PMID: 38589264 PMCID: PMC11015182 DOI: 10.1136/bmjopen-2023-077664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 03/27/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVES Describe new opioid prescription claims, their clinical indications and annual trends among opioid naïve adults covered by the Quebec's public drug insurance plan (QPDIP) for the fiscal years 2006/2007-2019/2020. DESIGN AND SETTING A retrospective observational study was conducted using data collected between 2006/2007 and 2019/2020 within the Quebec Integrated Chronic Disease Surveillance System, a linkage administrative data. PARTICIPANTS A cohort of opioid naïve adults and new opioid users was created for each study year (median number=2 263 380 and 168 183, respectively, over study period). INTERVENTION No. MAIN OUTCOME MEASURE AND ANALYSES A new opioid prescription was defined as the first opioid prescription claimed by an opioid naïve adult during a given fiscal year. The annual incidence proportion for each year was then calculated and standardised for age. A hierarchical algorithm was built to identify the most likely clinical indication for this prescription. Descriptive and trend analyses were performed. RESULTS There was a 1.7% decrease of age-standardised annual incidence proportion during the study period, from 7.5% in 2006/2007 to 5.8% in 2019/2020. The decrease was highest after 2016/2017, reaching 5.5% annual percentage change. Median daily dose and days' supply decreased from 27 to 25 morphine milligram equivalent/day and from 5 to 4 days between 2006/2007 and 2019/2020, respectively. Between 2006/2007 and 2019/2020, these prescriptions' most likely clinical indications increased for cancer pain from 34% to 48%, for surgical pain from 31% to 36% and for dental pain from 9% to 11%. Inversely, the musculoskeletal pain decreased from 13% to 2%. There was good consistency between the clinical indications identified by the algorithm and prescriber's specialty or user's characteristics. CONCLUSIONS New opioid prescription claims (incidence, dose and days' supply) decreased slightly over the last 14 years among QPDIP enrollees, especially after 2016/2017. Non-surgical and non-cancer pain became less common as their clinical indication.
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Affiliation(s)
- Eugene Attisso
- Quebec National Institute of Public Health, Quebec, Quebec, Canada
| | - Line Guenette
- Faculty of Pharmacy, Laval University, Quebec, Quebec, Canada
- Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Clermont E Dionne
- Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Faculty of Medicine, Laval University, Quebec, Quebec, Canada
| | - Edeltraut Kröger
- Faculty of Pharmacy, Laval University, Quebec, Quebec, Canada
- Sustainable Health Research Centre, VITAM, Quebec, Quebec, Canada
| | - Isaora Dialahy
- Quebec National Institute of Public Health, Quebec, Quebec, Canada
| | | | - Sonia Jean
- Quebec National Institute of Public Health, Quebec, Quebec, Canada
- Faculty of Medicine, Laval University, Quebec, Quebec, Canada
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Cheng FC, Wang YL, Chang WC, Chiang CP. The evolution of arsenic-containing traditional Chinese medicine prescriptions for treatment of toothache due to tooth decay. J Dent Sci 2024; 19:1251-1254. [PMID: 38618070 PMCID: PMC11010838 DOI: 10.1016/j.jds.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 04/16/2024] Open
Affiliation(s)
- Feng-Chou Cheng
- Chia-Te Dental Clinic, New Taipei City, Taiwan
- School of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
- Science Education Center, National Taiwan Normal University, Taipei, Taiwan
| | - Yin-Lin Wang
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Wen-Chiung Chang
- Division of Clinical Chinese Medicine, National Research Institute of Chinese Medicine, Ministry of Health and Welfare, Taipei, Taiwan
| | - Chun-Pin Chiang
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
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Plüss-Suard C, Mueller Y, Plate A, Senn O, Kronenberg A. Re: 'Impact of the COVID-19 pandemic on antibiotic prescribing in high-prescribing primary care physicians in Switzerland' by Aghlmandi et al. Clin Microbiol Infect 2024:S1198-743X(24)00139-3. [PMID: 38467245 DOI: 10.1016/j.cmi.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/04/2024] [Indexed: 03/13/2024]
Affiliation(s)
- Catherine Plüss-Suard
- Swiss Centre for Antibiotic Resistance (ANRESIS), Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
| | - Yolanda Mueller
- Department of Family Medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Andreas Plate
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Andreas Kronenberg
- Swiss Centre for Antibiotic Resistance (ANRESIS), Institute for Infectious Diseases, University of Bern, Bern, Switzerland
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Aghlmandi S, Halbeisen FS, Godet P, Signorell A, Sigrist S, Saccilotto R, Widmer AF, Zeller A, Bielicki J, Bucher HC. Impact of the COVID-19 pandemic on antibiotic prescribing in high-prescribing primary care physicians in Switzerland. Clin Microbiol Infect 2024; 30:353-359. [PMID: 38000535 DOI: 10.1016/j.cmi.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/15/2023] [Accepted: 11/19/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate antibiotic prescribing of medium-to-high prescribing primary care physicians being followed up after the completion of a Swiss national intervention trial of antibiotic prescription audit and feedback in the first SARS-CoV-2 pandemic year. METHODS We used health insurer based claims data to calculate monthly antibiotic prescription rates per 100 consultations (primary endpoint) and applying interrupted time series (ITS) analysis methods, we estimated the immediate (step change) and sustained effects (slope) of the SARS-CoV-2 epidemic in 2020 on antibiotic prescribing compared to the pre-pandemic trial period from 2017-2019. RESULTS We analysed data of 2945 of 3426 physicians (86.0%) from the trial with over 4 million consultations annually, who were in 2020 still in practice. Consultations dropped by 43% during the first pandemic year compared with 2017. Median monthly antibiotic prescription rates per 100 consultations in 2017 were 8.44 (Interquartile range [IQ] 6.32-11.50) and 8.35 (6.34-11.74) in the intervention and control groups, respectively, and increased to 15.63 (10.69-23.81) and 16.31 (10.65-24.72) per 100 consultations in 2020. ITS-derived incidence rate ratios for overall antibiotic prescriptions were 2.32 (95% CI 2.07-2.59) for the immediate pandemic effect, and 0.96 (0.95-0.98) for the sustained effect (change in slope in 2020 compared with 2017-2019). DISCUSSION The SARS-CoV-2 pandemic had a major impact on antibiotic prescription patterns in primary care in Switzerland. For future viral pandemics, intervention plans with timely activation steps to minimize unjustified antibiotic consumption in primary care should be prepared.
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Affiliation(s)
- Soheila Aghlmandi
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland; Paediatric Research Center, University Children's Hospital Basel (UKBB), Basel, Switzerland.
| | - Florian S Halbeisen
- Surgical Outcome Research Center, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | | | | | | | - Ramon Saccilotto
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Andreas F Widmer
- Division of Infectious Diseases and Hospital Hygiene, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Julia Bielicki
- Infectious Diseases and Paediatric Research Centre University of Basel Children's Hospital and University of Basel, Basel, Switzerland; Centre for Neonatal and Paediatric Infection, St. George's University, London, UK
| | - Heiner C Bucher
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
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Kostev K, Doege C, Jacob L. Prevalence of and factors associated with the early prescription of antiseizure medications in adults newly diagnosed with epilepsy in Germany. Epilepsy Behav 2024; 152:109655. [PMID: 38271779 DOI: 10.1016/j.yebeh.2024.109655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/17/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND There is little information on prescription patterns of antiseizure medications (ASMs) during the early management of patients with epilepsy in Germany. Therefore, this study investigated the prevalence of and the factors associated with ASM prescription in patients newly diagnosed with epilepsy in this country. METHODS Adults diagnosed for the first time with epilepsy in one of 128 neurology practices in Germany between 2005 and 2021 were included (Disease Analyzer database, IQVIA). The prescription of ASMs was assessed within 30 days, six months, and 12 months of the diagnosis. Covariates were demographic factors, epilepsy sub-diagnoses, and co-diagnoses frequently associated with epilepsy. RESULTS This study included 55,962 participants (mean [SD] age 52.5 [20.0] years; 50.5 % men). The prevalence of ASM prescription ranged from 45.0 % within 30 days to 66.0 % within 12 months of the diagnosis. Men were less likely to receive ASMs within six and 12 months of epilepsy diagnosis than women. In addition, epilepsy sub-diagnoses of symptomatic, complex, or generalized nature were associated with increased odds of ASM prescription compared with epilepsy of unspecified nature. Finally, there was an inverse and significant association between multiple co-diagnoses (e.g., diabetes, mental and behavioral disorders due to use of alcohol, and traumatic brain injury) and ASM prescribing. CONCLUSIONS A substantial proportion of participants were prescribed ASMs in the year following epilepsy diagnosis, highlighting that the early prescription of ASMs was necessary for these patients. Further research is warranted to corroborate the present findings in other countries and settings.
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Affiliation(s)
| | - Corinna Doege
- Department of Pediatric Neurology, Center of Pediatrics and Adolescent Medicine, Central Hospital Bremen, 28205 Bremen, Germany
| | - Louis Jacob
- AP-HP, Université Paris Cité, Lariboisière-Fernand Widal Hospital, Department of Physical Medicine and Rehabilitation, 75010 Paris, France; Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases (EpiAgeing), 75010 Paris, France; Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830 Barcelona, Spain.
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Bělobrádek J, Šídlo L, Philipp T. Influence of practice location on prescribing, diabetes care, and colorectal cancer screening among Czech general practitioners during the COVID-19 pandemic. Epidemiol Health 2024; 46:e2024033. [PMID: 38453333 DOI: 10.4178/epih.e2024033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/10/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVES The provision of primary health care was not interrupted during the coronavirus disease 2019 (COVID-19) pandemic in Czechia, although the capacity and resources of providers changed. We examined how the pandemic affected individual general practices throughout 2017-2021, focusing on differences between urban and rural practices. METHODS We analysed data from the largest health insurance company in Czechia, which provides care to 4.5 million people (60% of the population). We evaluated the prescription volume, diabetes care procedures, and faecal immunochemical test (FIT) in preventive care and new pandemic-related procedures (remote consultations, testing, and vaccinations). For the spatial distribution of practices, we adapted the Organisation for Economic Cooperation and Development typology. RESULTS We observed minimal declines in 2020 in the rate of prescribing (-1.0%) and diabetes care (-5.1%), with a rapid resumption in 2021, but a substantial decline in FIT (-17.8% in 2020) with slow resumption. Remote consultations were used by 94% of all practices regardless of location, with testing and vaccinations more commonly performed by rural general practitioners (GPs). CONCLUSIONS Primary care in Czechia rose to the challenge of the COVID-19 pandemic, as shown by the finding that the volume of healthcare services provided through primary care did not decrease across most of the monitored parameters. This study also confirmed that rural GPs provide more care in-house, both in terms of prescribing and procedures performed in their practices. Future studies will need to focus on preventive care, which the pandemic has dampened in GP practices in Czechia.
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Affiliation(s)
- Jan Bělobrádek
- Institute of Preventive Medicine, Charles University Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic
| | - Luděk Šídlo
- Department of Demography and Geodemography, Charles University Faculty of Science, Praha, Czech Republic
| | - Tom Philipp
- General Health Insurance Company (GHIC), Praha, Czech Republic
- Charles University, Third Faculty of Medicine, Rheumatology and Rehabilitation Clinic, Praha, Czech Republic
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Nicodemo C, Orso CE, Tealdi C. Overseas general practitioners (GPs) and prescription behaviour in England. Health Policy 2024; 140:104967. [PMID: 38142570 DOI: 10.1016/j.healthpol.2023.104967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/27/2023] [Accepted: 12/11/2023] [Indexed: 12/26/2023]
Abstract
The UK imports many doctors from abroad, where medical training and experience may differ. This study aims to understand how drug prescription behaviour varies in English GP practices with higher shares of foreign-trained GPs. Results indicate that in general prac- tices with a high proportion of GPs trained outside the UK, there are higher prescriptions for antibiotics, mental health medication, analgesics, antacids, and statins, while controlling for patient and practice characteristics. However, we found no significant impact on pa- tient satisfaction or unplanned hospitalisations, suggesting that this behaviour may be due to over-prescribing. Identifying differences in prescribing habits amongst GPs is crucial in deter- mining best policies for ensuring consistent services across GP practices and reducing health inequalities.
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Affiliation(s)
- Catia Nicodemo
- Department of Primary Health Care, Medical School, Department of Primary Care, University of Oxford, Walton Street OX2 6GG, Oxford, UK; Department of Economics, University of Verona, Via Cantarane 24, Verona 03678, Italy.
| | - Cristina E Orso
- Department of Law, Economics, and Cultures, University of Insubria, Italy
| | - Cristina Tealdi
- Edinburgh Business School, IZA Institute of Labor, Heriot-Watt University, Edinburgh EH14 4AS, UK
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Wu Y, Zhang J, Liu Q, Miao Z, Chai R, Chen W. Development of Chinese herbal medicine for sensorineural hearing loss. Acta Pharm Sin B 2024; 14:455-467. [PMID: 38322328 PMCID: PMC10840432 DOI: 10.1016/j.apsb.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/16/2023] [Accepted: 10/24/2023] [Indexed: 02/08/2024] Open
Abstract
According to the World Health Organization's world report on hearing, nearly 2.5 billion people worldwide will suffer from hearing loss by 2050, which may contribute to a severe impact on individual life quality and national economies. Sensorineural hearing loss (SNHL) occurs commonly as a result of noise exposure, aging, and ototoxic drugs, and is pathologically characterized by the impairment of mechanosensory hair cells of the inner ear, which is mainly triggered by reactive oxygen species accumulation, inflammation, and mitochondrial dysfunction. Though recent advances have been made in understanding the ability of cochlear repair and regeneration, there are still no effective therapeutic drugs for SNHL. Chinese herbal medicine which is widely distributed and easily accessible in China has demonstrated a unique curative effect against SNHL with higher safety and lower cost compared with Western medicine. Herein we present trends in research for Chinese herbal medicine for the treatment of SNHL, and elucidate their molecular mechanisms of action, to pave the way for further research and development of novel effective drugs in this field.
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Affiliation(s)
- Yunhao Wu
- State Key Laboratory of Bioelectronics, Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital, School of Life Sciences and Technology, Advanced Institute for Life and Health, Jiangsu Province High-Tech Key Laboratory for Bio-Medical Research, Southeast University, Nanjing 210096, China
| | - Jingwen Zhang
- Department of Otolaryngology-Head and Neck, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Qiuping Liu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Hospital of Jiangnan University, Wuxi 214000, China
| | - Zhuang Miao
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Hospital of Jiangnan University, Wuxi 214000, China
| | - Renjie Chai
- State Key Laboratory of Bioelectronics, Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital, School of Life Sciences and Technology, Advanced Institute for Life and Health, Jiangsu Province High-Tech Key Laboratory for Bio-Medical Research, Southeast University, Nanjing 210096, China
- Department of Otolaryngology Head and Neck Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610000, China
- Co-Innovation Center of Neuroregeneration, Nantong University, Nantong 226001, China
- Institute for Stem Cell and Regeneration, Chinese Academy of Science, Beijing 100085, China
- Beijing Key Laboratory of Neural Regeneration and Repair, Capital Medical University, Beijing 100069, China
| | - Wenyong Chen
- Department of Otolaryngology-Head and Neck, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China
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Adashi EY, O'Mahony DP, Cohen IG. Medicare Advantage: Growth Amidst Mounting Scrutiny. J Am Board Fam Med 2024; 36:1062-1064. [PMID: 37857442 DOI: 10.3122/jabfm.2023.230111r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 10/21/2023] Open
Abstract
The Medicare Advantage Program, home to nearly half of the eligible Medicare population, has recently come under increased scrutiny. The Government Accountability Office called on the Centers for Medicare & Medicaid Services to monitor "disenrollment of MA beneficiaries in the last year of life, validate MA-provided encounter data, and strengthen audits used to identify and recover improper payments to MA plans." The House Subcommittee on Oversight and Investigations of the Committee on Energy & Commerce, dedicated a hearing to "Protecting America's Seniors: Oversight of Private Sector Medicare Advantage Plans." In addition, a recently conducted audit of the Office of the Inspector General of the Department of Health and Human Services raised concerns over "denials of prior authorization requests" and "beneficiary access to medically necessary care." In this article we consider the backdrop for the growing scrutiny of the MA program and the implications thereof to its future trajectory.
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Affiliation(s)
- Eli Y Adashi
- From the Professor of Medical Science, Former Dean of Medicine and Biological Sciences, Brown University, Providence, RI (EYD); Director, Library Planning and Assessment, Brown University Library, Brown University, Providence, RI (DPO); Deputy Dean and James A. Attwood and Leslie Williams Professor of Law, Harvard Law School, Faculty Director, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard University, Cambridge, MA (IGC)
| | - Daniel P O'Mahony
- From the Professor of Medical Science, Former Dean of Medicine and Biological Sciences, Brown University, Providence, RI (EYD); Director, Library Planning and Assessment, Brown University Library, Brown University, Providence, RI (DPO); Deputy Dean and James A. Attwood and Leslie Williams Professor of Law, Harvard Law School, Faculty Director, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard University, Cambridge, MA (IGC)
| | - I Glenn Cohen
- From the Professor of Medical Science, Former Dean of Medicine and Biological Sciences, Brown University, Providence, RI (EYD); Director, Library Planning and Assessment, Brown University Library, Brown University, Providence, RI (DPO); Deputy Dean and James A. Attwood and Leslie Williams Professor of Law, Harvard Law School, Faculty Director, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard University, Cambridge, MA (IGC)
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Babar P, Qaiser U, Rehman IU. Assessment of prescription writing skills among dental house officers: A multi-center study. Pak J Med Sci 2024; 40:170-173. [PMID: 38196487 PMCID: PMC10772446 DOI: 10.12669/pjms.40.1.7688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/08/2023] [Accepted: 09/02/2023] [Indexed: 01/11/2024] Open
Abstract
Objective To assess the knowledge and skills of prescription writing among dental house officers from different hospitals. Methods This cross-sectional study was conducted from July to September, 2022. A self-administered, structured questionnaire was used to collect data from 180 house officers from four teaching dental hospitals (n=45 each). The participants were asked to write a prescription for an adult and a pediatric patient. The prescription was evaluated according to WHO criteria. Analysis was done using SPSS v.20. Data was presented as frequencies and percentages. Results Among the 180 participants, 42.9% were males and 57.1% were females. 33.9% participants reported prescription writing to be a difficult task. Only 36.7% participants reported to be trained in prescribing pediatric medications. None of the prescriptions completely fulfilled the WHO criteria. Doctor related information (name, address and contact no) was written by only 3.8% of the participants while 10% of the participants mentioned the patient related information (name, address and age). Dosage of the prescribed drugs was the most commonly drug-related missing parameter which was mentioned in 30% of the pediatric prescriptions and 21% of the adult prescriptions. Conclusion There is a general lack of knowledge among the dental house officers regarding prescription writing as they were found to be unaware of the essential elements of a prescription. The findings call for an urgent change in the undergraduate teaching of prescription writing skills with special emphasis on pediatric drugs and dosage.
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Affiliation(s)
- Palwasha Babar
- Palwasha Babar, MDS Assistant Professor, Department of Paediatric Dentistry, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, Pakistan
| | - Uswa Qaiser
- Uswa Qaiser, BDS Demonstrator, Department of Operative and Pediatric Dentistry, University College of Dentistry, The University of Lahore, Lahore, Pakistan
| | - Ijaz ur Rehman
- Ijaz ur Rehman, FCPS Assistant Professor, Department of Oral Medicine, University College of Dentistry, The University of Lahore, Lahore, Pakistan
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Oh J, Yeo J. Trends in the prescription of opioids and gabapentinoids in patients with failed back surgery syndrome in Korea: a population-based study. Korean J Pain 2024; 37:73-83. [PMID: 38130090 PMCID: PMC10764216 DOI: 10.3344/kjp.23246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Background Failed back surgery syndrome (FBSS) is a chronic condition that is characterized by persistent back pain following one or more spinal surgeries. Pharmacological interventions, such as the use of opioids and gabapentinoids, are frequently used in the treatment of FBSS. However, prolonged and excessive use of these medications can lead to dependence and adverse effects. This study investigates trends in opioid and gabapentinoid prescriptions among patients with FBSS in Korea from 2016 to 2020. Methods Data from the Health Insurance and Review Agency were analyzed, and claims listing FBSS were selected for the study. Prescription patterns of opioids and gabapentinoids were classified based on the number of days prescribed per year. Results Of the 390,095 patients diagnosed with FBSS, 41.6% of the patients were prescribed gabapentinoids, and 42.0% of them were prescribed opioids, while 10.6% of the patients were classified as long-term gabapentinoid users, 11.4% as long-term opioid users, and 7.4% of the patients were found to have long-term prescriptions for both drugs. The proportion of patients who received both gabapentinoid and opioid prescriptions increased annually. The doses of opioids prescribed have also increased along with the increase in the number of patients receiving opioid prescriptions. Conclusions The prescription rates of opioids and gabapentinoids among patients with FBSS in Korea continue to increase steadily, posing potential risks of addiction and adverse effects. Further research is needed to better understand the actual status of addiction in patients with FBSS.
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Affiliation(s)
- Jinyoung Oh
- Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Kyunpook National University Chilgok Hospital, Daegu, Korea
| | - Jinseok Yeo
- Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Kyunpook National University Chilgok Hospital, Daegu, Korea
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Gawish AS, ElMofty MS, Jambi S, Felemban D, Ragheb YS, Elsayed SA. Phytotherapy in periodontics as an effective and sustainable supplemental treatment: a narrative review. J Periodontal Implant Sci 2023; 54:54.e1. [PMID: 38290997 DOI: 10.5051/jpis.2301420071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/27/2023] [Accepted: 11/02/2023] [Indexed: 02/01/2024] Open
Abstract
PURPOSE Periodontal disease is a chronic condition caused by microbial infection and mediated by the host's immune response. Phytotherapy is a therapeutic approach that utilizes a renewable resource capable of supplying less expensive medicines for the world's growing population. This review aimed to present clinical evidence on the use of complementary medicinal herbs in the treatment of periodontal diseases. METHODS Different databases were searched using the terms "herbal" and "periodontitis." All included studies were examined with a focus on herbal indications, type, and prescription length. Dentists' therapeutic and prophylactic herbal prescribing habits were also assessed. RESULTS Various herbs such as turmeric, neem, aloe-vera, pomegranate, catechu, tulsi, cloves, lemon grass, green tea, tea tree oil, peppermint, garlic, pineapple, oak bark, babul, bakul, sage, coriander, moringa, amla, guava, and grape seed extract have been used in the treatment of periodontitis. These herbs have been reported to exhibit a range of therapeutic effects, including anti-inflammatory, antiplaque, antihalitosis, antiresorptive, antioxidant, antibacterial, antifungal, antiviral, and antimicrobial properties. These components can be utilized in various forms such as mouth rinse, gel, oil, toothpaste, aqueous extract, mouthwash, or tooth powder. CONCLUSIONS Several readily available herbal formulations are now available on the market and have been shown to be effective as supplemental periodontal phytotherapy. However, these should be used under the supervision of a dental professional to ensure optimal benefits and effectiveness. Therefore, it is necessary to improve the understanding of suggested herbal prescription practices among dental professionals.
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Affiliation(s)
- Abeer Saad Gawish
- Dean of Postgraduate Faculty, Sinai University, El Arish Branch, El Arish, Egypt
- Department of Oral Medicine and Periodontology, Faculty of Dental Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohammed Sherif ElMofty
- Community Service and Environmental Development, Faculty of Dentistry, Nahda University, Beni Suef, Egypt
- Department of Oral Medicine, Periodontology and Oral Diagnosis Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Safa Jambi
- Department of Preventive Dental Sciences, College of Dentistry, Taibah University, Almadinah Almunawwarah, Saudi Arabia
| | - Doaa Felemban
- Department of Oral & Maxillofacial Diagnostic Sciences, College of Dentistry, Taibah University, Almadinah Almunawwarah, Saudi Arabia
| | | | - Shadia Abdelhameed Elsayed
- Department of Oral Medicine and Periodontology, Faculty of Dental Medicine, Al-Azhar University, Cairo, Egypt
- Department of Oral & Maxillofacial Diagnostic Sciences, College of Dentistry, Taibah University, Almadinah Almunawwarah, Saudi Arabia.
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Miura R, Okada K. Prescription of renin-angiotensin system inhibitors in Japan during the COVID-19 pandemic: interrupted time series study. Hypertens Res 2023; 46:2593-2602. [PMID: 37463982 DOI: 10.1038/s41440-023-01373-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/20/2023]
Abstract
We surveyed changes in angiotensin-converting enzyme inhibitor (ACEIs) and angiotensin II receptor blocker (ARBs) prescription trends during the coronavirus disease 2019 (COVID-19) pandemic in Japan. Data of 1,605,708 outpatients with hypertension were extracted from the Medical Data Vision database. Trends for prescription of ACEIs and ARBs were assessed by analyzing the proportion of these prescriptions in each month, between April 2018 and November 2020. The proportion of ARBs prescriptions changed significantly in trend between the peri-pandemic and pre-pandemic periods (-0.05%/month, P = 0.012). In contrast, the proportion of ACEIs prescriptions did not change significantly in trend in the peri-pandemic period (0.01%/month, P = 0.189). There was no suggestion that the prescribing of ACEIs and ARBs was affected by the COVID-19 pandemic.
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Affiliation(s)
- Ryosuke Miura
- Department of Pharmacy, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8512, Japan.
| | - Kouji Okada
- Department of Pharmacy, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8512, Japan
- Division of Clinical Pharmaceutics and Pharmacy Practice, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8512, Japan
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Al Kasbi S, Obaid Y, Al Adawi S, Jaju S. The Practice of Prescribing Antidepressants During Pregnancy and Breastfeeding Among Mental Health Practitioners in Tertiary Care Centers in Oman. Oman Med J 2023; 38:e572. [PMID: 38264515 PMCID: PMC10801695 DOI: 10.5001/omj.2023.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 07/05/2023] [Indexed: 01/25/2024] Open
Abstract
Objectives This study sought to determine the confidence level of mental health practitioners in Oman regarding the use of antidepressants during pregnancy and breastfeeding, assess their knowledge and need for further training in this area, and examine their current prescribing patterns and preferences. Methods A questionnaire-based survey was conducted from May to June 2017 among all practitioners in the psychiatry specialty, including medical officers authorized to prescribe medications, at the Behavioral Medicine Department of Sultan Qaboos University Hospital and Al Masarra Hospital. Results Forty-two practitioners (response rate = 89.4%) responded to the questionnaire. Of them, 10 (23.8%) had no experience, while 30 (71.4%) had experience in prescribing antidepressants during both pregnancy and breastfeeding periods. Twenty-seven (64.3%) respondents felt that they were confident in prescribing antidepressants for women during their perinatal period, while 30.0% were neutral. Moreover, 35 (83.3%) participants expressed the need for more training in this area. Furthermore, 34 (81.0%) believed that more training in perinatal psychiatry should be included in the psychiatry curriculum. There was no consistent prescribing pattern (either prescribing or avoiding) among our participating practitioners during the first trimester of pregnancy and breastfeeding periods. The drug of choice in the first trimester of pregnancy was fluoxetine preferred by approximately 85.0% of the practitioners, but avoided by 10.0% of practitioners in the same period. This was followed by amitriptyline (50.0% vs. 23.0%), sertraline (50.0% vs. 9.0%), imipramine (28.0% vs. 84.0%). During breastfeeding, the drug of choice for approximately 74.0% of the practitioners was paroxetine, but avoided by 15.0% of practitioners. This was followed by sertraline (50.0% vs. 8.0%). The most common reasons for prescription during pregnancy were safety, evidence-based practice, and low teratogenicity. For breastfeeding, the main reasons for prescription were low levels of the drug in breast milk, safety, and evidence-based practice. On the other hand, high teratogenicity, neonatal side effects, limited data, and lack of evidence were among the most common reasons behind avoiding prescribing during pregnancy, while high levels of breast milk, neonatal side effects, limited evidence, and safety concerns were the most common reasons during the breastfeeding period. Conclusions There was inconsistency among mental health practitioners in making prescription decisions and in their prescribing patterns.
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Affiliation(s)
| | - Yousif Obaid
- Department of Behavioral Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Samir Al Adawi
- Department of Behavioral Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sanjay Jaju
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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Fu M, Gong Z, Li C, Ling K, Zhu Y, Li H, Shi L, Guan X. Appropriate use of antibiotics for acute respiratory infections at primary healthcare facilities in China: a nationwide cross-sectional study from 2017 to 2019. Lancet Reg Health West Pac 2023; 40:100880. [PMID: 37636127 PMCID: PMC10458636 DOI: 10.1016/j.lanwpc.2023.100880] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/25/2023] [Accepted: 08/06/2023] [Indexed: 08/29/2023]
Abstract
Background The appropriateness of antibiotic use for acute respiratory infections (ARIs) in Chinese primary healthcare facilities (PHFs) remained uncertain. We aimed to evaluate to what degree antibiotic prescribing for ARIs were aligned with guideline recommendations in primary settings across China. Methods We collected outpatient prescriptions from 262 Chinese PHFs in 27 cities of six provinces between 2017 and 2019. The appropriate antibiotic prescribing was defined as prescribing antibiotic classes that were recommended by Chinese clinical guidelines, if patients were prescribed antibiotics. We evaluated the magnitude of antibiotics prescribed for acute upper respiratory infections (AURIs), acute bronchitis, and community-acquired pneumonia (CAP) and their appropriateness. Findings Overall, 55.1% (87,684/159,150), 66.8% (30,836/46,153), and 68.5% (4615/6733) of outpatients with AURIs, acute bronchitis, and CAP treated at PHFs in China were prescribed with antibiotics. Of all antibiotic prescriptions, only 20.0% (17,542/87,684), 18.6% (5724/30,836) and 69.6% (3211/4615) used antibiotic classes that were recommended by the guidelines for AURIs, acute bronchitis, and CAP, respectively. Patients residing in the Chinese central region (17.0%, 15.4%, 69.3% for AURIs, acute bronchitis, and CAP, respectively) were less likely to be prescribed with antibiotics that were appropriately selected. Interpretation Unnecessary antibiotics were widely prescribed for patients with AURIs or acute bronchitis and most patients with ARIs did not receive guideline-recommended antibiotic classes in Chinese PHFs. Interventions to promote evidence-based treatment and the appropriate use of antibiotics are urgently needed at the primary level across China. Funding This work was supported by the National Natural Science Foundation of China [grant number 72074007, 81973294].
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Affiliation(s)
- Mengyuan Fu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Zhiwen Gong
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Can Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Kexin Ling
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Yuezhen Zhu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Huangqianyu Li
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
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LeFevre N, St Louis J, Worringer E, Younkin M, Stahl N, Sorcinelli M. The End of the X-waiver: Excitement, Apprehension, and Opportunity. J Am Board Fam Med 2023; 36:867-872. [PMID: 37704389 DOI: 10.3122/jabfm.2023.230048r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 09/15/2023] Open
Abstract
With the passage of the MAT act (Mainstreaming Addiction Treatment) and the MATE Act (Medication Training and Expansion), the Drug Enforcement Agency "X-waiver" program governing the office-based prescription of buprenorphine for opioid use disorder has been immediately eliminated. The move was championed by vocal organizations with a rightful concern about buprenorphine access but was opposed by most physicians. Nonetheless, buprenorphine can now be prescribed like any schedule 3 medication. Studies show that despite rising opioid overdoses, buprenorphine prescription increases have been slow to rise and are particularly absent in rural communities. The elimination of the X-waiver may theoretically improve buprenorphine prescribing rates for opioid use disorder in rural areas, by nurse practitioners and physician assistants, and by resident physicians in teaching programs. It may also help decrease discrimination against individuals with opioid use disorder in postacute-care settings like nursing homes, physical rehabilitation centers, and in prisons and jails. Concerns include the elimination of the only focused opioid use disorder education many physicians receive (X-waiver courses) and a literature base showing that interest, rather than the X-waiver itself, remains the biggest barrier to recruiting more buprenorphine prescribers. Concerns also exist over the harms of precipitated withdrawal when buprenorphine is initiated inappropriately. The change of the elimination of the X-waiver brings about a new opportunity for Family Medicine and its parent organizations to champion the inclusion of opioid use disorder treatment within the chronic disease care models well-known to our integrated care settings.
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Affiliation(s)
- Nicholas LeFevre
- From the Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MO; Department of Family Medicine, Tufts University School of Medicine, Core Faculty, Lawrence Family Medicine Residency, Lawrence, MA (JSL); Rush-Esperanza Family Medicine Residency, Chicago, IL (EW); Harm Reduction Services, Boston Health Care for the Homeless Program, Clinical Assistant Professor, Department of Family Medicine, Tufts University School of Medicine, Boston, MA (MY); Department of Family Medicine, Tufts University School of Medicine, Addiction Consult Service, Lawrence General Hospital, Community Faculty, Lawrence Family Medicine Residency, Lawrence, MA (NS); Office Based Addiction Treatment Program, Greater Lawrence Family Health Center, Community Faculty, Lawrence Family Medicine Residency, Lawrence, MA (MS).
| | - Joshua St Louis
- From the Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MO; Department of Family Medicine, Tufts University School of Medicine, Core Faculty, Lawrence Family Medicine Residency, Lawrence, MA (JSL); Rush-Esperanza Family Medicine Residency, Chicago, IL (EW); Harm Reduction Services, Boston Health Care for the Homeless Program, Clinical Assistant Professor, Department of Family Medicine, Tufts University School of Medicine, Boston, MA (MY); Department of Family Medicine, Tufts University School of Medicine, Addiction Consult Service, Lawrence General Hospital, Community Faculty, Lawrence Family Medicine Residency, Lawrence, MA (NS); Office Based Addiction Treatment Program, Greater Lawrence Family Health Center, Community Faculty, Lawrence Family Medicine Residency, Lawrence, MA (MS)
| | - Emma Worringer
- From the Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MO; Department of Family Medicine, Tufts University School of Medicine, Core Faculty, Lawrence Family Medicine Residency, Lawrence, MA (JSL); Rush-Esperanza Family Medicine Residency, Chicago, IL (EW); Harm Reduction Services, Boston Health Care for the Homeless Program, Clinical Assistant Professor, Department of Family Medicine, Tufts University School of Medicine, Boston, MA (MY); Department of Family Medicine, Tufts University School of Medicine, Addiction Consult Service, Lawrence General Hospital, Community Faculty, Lawrence Family Medicine Residency, Lawrence, MA (NS); Office Based Addiction Treatment Program, Greater Lawrence Family Health Center, Community Faculty, Lawrence Family Medicine Residency, Lawrence, MA (MS)
| | - Morgan Younkin
- From the Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MO; Department of Family Medicine, Tufts University School of Medicine, Core Faculty, Lawrence Family Medicine Residency, Lawrence, MA (JSL); Rush-Esperanza Family Medicine Residency, Chicago, IL (EW); Harm Reduction Services, Boston Health Care for the Homeless Program, Clinical Assistant Professor, Department of Family Medicine, Tufts University School of Medicine, Boston, MA (MY); Department of Family Medicine, Tufts University School of Medicine, Addiction Consult Service, Lawrence General Hospital, Community Faculty, Lawrence Family Medicine Residency, Lawrence, MA (NS); Office Based Addiction Treatment Program, Greater Lawrence Family Health Center, Community Faculty, Lawrence Family Medicine Residency, Lawrence, MA (MS)
| | - Natalie Stahl
- From the Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MO; Department of Family Medicine, Tufts University School of Medicine, Core Faculty, Lawrence Family Medicine Residency, Lawrence, MA (JSL); Rush-Esperanza Family Medicine Residency, Chicago, IL (EW); Harm Reduction Services, Boston Health Care for the Homeless Program, Clinical Assistant Professor, Department of Family Medicine, Tufts University School of Medicine, Boston, MA (MY); Department of Family Medicine, Tufts University School of Medicine, Addiction Consult Service, Lawrence General Hospital, Community Faculty, Lawrence Family Medicine Residency, Lawrence, MA (NS); Office Based Addiction Treatment Program, Greater Lawrence Family Health Center, Community Faculty, Lawrence Family Medicine Residency, Lawrence, MA (MS)
| | - Mia Sorcinelli
- From the Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MO; Department of Family Medicine, Tufts University School of Medicine, Core Faculty, Lawrence Family Medicine Residency, Lawrence, MA (JSL); Rush-Esperanza Family Medicine Residency, Chicago, IL (EW); Harm Reduction Services, Boston Health Care for the Homeless Program, Clinical Assistant Professor, Department of Family Medicine, Tufts University School of Medicine, Boston, MA (MY); Department of Family Medicine, Tufts University School of Medicine, Addiction Consult Service, Lawrence General Hospital, Community Faculty, Lawrence Family Medicine Residency, Lawrence, MA (NS); Office Based Addiction Treatment Program, Greater Lawrence Family Health Center, Community Faculty, Lawrence Family Medicine Residency, Lawrence, MA (MS)
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Meurant A, Lescure P, Lafont C, Pommier W, Delmas C, Descatoire P, Baudon M, Muzard A, Villain C, Jourdan JP. Implementation of clinical medication review in a geriatric ward to reduce potentially inappropriate prescriptions among older adults. Eur J Clin Pharmacol 2023; 79:1391-1400. [PMID: 37597081 DOI: 10.1007/s00228-023-03551-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE The impact of several pharmaceutical interventions to reduce the use of potentially inappropriate medications (PIMs) and potentially omitted medications (POMs) has been recently studied. We aimed to determine whether clinical medication review (CMR) (i.e. a systematic and patient-centred clinical assessment of all medicines currently taken by a patient) performed by a geriatrician and a pharmacist added to standard pharmaceutical care (SPC) (i.e. medication reconciliation and regular prescription review by the pharmacist) resulted in more appropriate prescribing compared to SPC among older inpatients. METHODS A retrospective observational single-centre study was conducted in a French geriatric ward. Six criteria for appropriate prescribing were chosen: the number of PIMs and POMs as defined by the STOPP/STARTv2 list, the total number of drugs prescribed, the number of administrations per day and the number of psychotropic and anticholinergic drugs. These criteria were compared between CMR and SPC group using linear and logistic regression models weighted on propensity scores. RESULTS There were 137 patients included, 66 in the CMR group and 71 in the SPC group. The mean age was 87 years, the sex ratio was 0.65, the mean number of drugs prescribed was 9, the mean MMSE was 21 and at admission 242 POMs, and 363 PIMs were prescribed. Clinical medication review did not reduce the number of PIMs at discharge compared to SPC (beta = - 0.13 [- 0.84; 0.57], p = 0.71) nor did it reduce the number of drugs prescribed (p = 0.10), the number of psychotropic drugs (p = 0.17) or the anticholinergic load (p = 0.87). Clinical medication review resulted in more POMs being prescribed than in standard pharmaceutical care (beta = - 0.39 [- 0.72; - 0.06], p = 0.02). Cardiology POMs were more implemented in the medication review group (p = 0.03). CONCLUSION Clinical medication review did not reduce the number of PIMs but helped clinicians introduce underused drugs, especially cardiovascular drugs, which are known to be associated with morbidity and mortality risk reduction.
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Affiliation(s)
- Alexandre Meurant
- Department of Geriatrics, University Hospital of Caen Normandie, Caen, France.
- Department of Pharmacy, University Hospital of Caen Normandie, Caen, France.
| | - Pascale Lescure
- Department of Geriatrics, University Hospital of Caen Normandie, Caen, France
| | - Claire Lafont
- Department of Geriatrics, University Hospital of Caen Normandie, Caen, France
| | - Wilhelm Pommier
- Department of Geriatrics, University Hospital of Caen Normandie, Caen, France
| | - Claire Delmas
- Department of Geriatrics, University Hospital of Caen Normandie, Caen, France
| | - Pablo Descatoire
- Department of Geriatrics, University Hospital of Caen Normandie, Caen, France
- Normandie University, Unicaen, INSERM U1075, COMETE, Caen, France
| | - Marie Baudon
- Department of Pharmacy, University Hospital of Caen Normandie, Caen, France
| | - Alexandra Muzard
- Department of Pharmacy, University Hospital of Caen Normandie, Caen, France
| | - Cédric Villain
- Department of Geriatrics, University Hospital of Caen Normandie, Caen, France
- Normandie University, Unicaen, INSERM U1075, COMETE, Caen, France
| | - Jean-Pierre Jourdan
- Department of Pharmacy, Vire Hospital, Vire, France
- Normandie University, UNICAEN, CERMN (Centre d'Etudes et de Recherche sur le Médicament de Normandie), F-14032, Caen, France
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Wang HC, Djajalaksana S, Sharma L, Theerakittikul T, Lim HF, Yoo KH, Yu-Lin AB, Diaz DV, Yang L, Beekman MJHI. Evaluation of short-acting Beta-2-agonist prescriptions and associated clinical outcomes: Findings from the SABA use IN Asthma (SABINA) study in Asia. World Allergy Organ J 2023; 16:100823. [PMID: 37869560 PMCID: PMC10587767 DOI: 10.1016/j.waojou.2023.100823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 09/01/2023] [Accepted: 09/13/2023] [Indexed: 10/24/2023] Open
Abstract
Background The extent of short-acting Beta-2-agonist (β2-agonist) (SABA) use across Asian countries is not well documented. As part of the SABA use IN Asthma (SABINA) III study, we assessed SABA prescriptions and clinical outcomes in patients with asthma from Asia. Methods This cross-sectional study recruited patients (aged ≥12 years) with asthma from 8 Asian countries. Data on disease characteristics and asthma treatments were collected using electronic case report forms. Patients were classified by practice type (primary or specialist care) and investigator-defined asthma severity (per Global Initiative for Asthma [GINA] 2017 recommendations). The association of SABA prescriptions with clinical outcomes was analyzed using multivariable regression models. Results Overall, 3066 patients were analyzed, with a mean (standard deviation) age of 51.8 (16.7) years; of these patients, 2116 (69%) were female, 2517 (82.1%) had moderate-to-severe asthma and 2498 (81.5%) and 559 (18.2%) were treated in specialist and primary care, respectively. In total, 1423 (46.4%) patients had partly controlled/uncontrolled asthma, with 1149 (37.5%) patients experiencing ≥1 severe asthma exacerbation in the previous year. Overall, 800 (26.7%) patients were prescribed ≥3 SABA canisters in the previous year, which is regarded as overprescription and was associated with a significantly decreased odds of at least partly controlled asthma and increased incidence rates of severe exacerbations (P < 0.01 for both associations). Conclusion The findings from this cohort of predominantly specialist-treated patients with asthma indicate SABA overprescription in at least 1 in every 4 patients, and this overprescription is associated with poor clinical outcomes. These data highlight the need for adherence to recently updated asthma treatment recommendations in Asia.
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Affiliation(s)
- Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University Hospital, Zhongzheng District, Taipei City 100, Taiwan
| | - Susanthy Djajalaksana
- Department of Pulmonology, University of Brawijaya-Dr. Saiful Anwar General Hospital, Kota Malang, Jawa Timur 65112, Indonesia
| | - Latha Sharma
- Department of Pulmonology, KIMS Hospitals, Secunderabad, Telangana, India
| | - Theerakorn Theerakittikul
- Department of Internal Medicine, Faculty of Medicine Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Hui Fang Lim
- National University Hospital, 5 Lower Kent Ridge Rd 119074, Singapore
- National University of Singapore, Yong Loo Lin School of Medicine, 10 Medical Dr 117597, Singapore
| | - Kwang Ha Yoo
- Division of Pulmonology and Allergy, Konkuk University Medical Center, Seoul, Korea 120-1 Neungdong-ro, Gwanjin-gu Seoul, 05030, South Korea
| | - Andrea Ban Yu-Lin
- Respiratory Unit, Dept of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur 56000, Malaysia
| | - Dina V Diaz
- Department of Pulmonary, Critical Care and Sleep Medicine, Lung Center of the Philippines, Quezon City, National Capital Region, 1100, Philippines
| | - Lala Yang
- Medical Affairs, AstraZeneca, Taiwan
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Landry H, Kingsbury M, Hamilton HA, Colman I. Psychological distress, non-medical use of prescription medications, and perceived unmet mental health care needs: a cross-sectional study of Ontario students. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1483-1492. [PMID: 36932238 DOI: 10.1007/s00127-023-02450-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/27/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE The non-medical use of prescription medications among adolescents has become a concerning public health issue. This study assessed the prevalence of the non-medical use of prescription medications in Ontario high school students, and explored the moderating effect of this use on the relationship between psychological distress and unmet mental health needs. METHODS Cross-sectional data for 4896 students, age 14-18, were drawn from the 2019 Ontario Student Drug Use and Health Survey. Psychological distress was measured using the Kessler-6 Distress Scale, unmet mental health needs were defined by self-report (yes/no), and non-prescription medication use was defined by self-reported frequency of use. Using logistic regression, we explored the effect of the non-medical use of prescription medications on the relationship between psychological distress and unmet mental health needs. RESULTS High proportions of Ontario students reported serious psychological distress (22%), some degree of unmet mental health need (38%), and/or non-medical use of prescription medications (13%). While there were strong associations between psychological distress and unmet mental health need, this association was weaker among those reporting non-medical use of prescription medications (OR = 3.3, 95% CI 1.9-5.7) compared to non-users (OR = 5.6, 95% CI 4.5-7.1). CONCLUSION Our findings suggest that Ontario students experiencing distress and using non-prescribed medications are less likely to identify a need for mental health support, highlighting the consequences of apparent self-medication through misuse of prescription medications. To assist in the redirection of adolescent perceptions of healthy coping strategies, population-based educational programming, with targeted promotion of both formal and informal mental health care resources, should be considered.
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Affiliation(s)
- Hannah Landry
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 308C, Ottawa, ON, K1G 5Z3, Canada
| | - Mila Kingsbury
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 308C, Ottawa, ON, K1G 5Z3, Canada
| | - Hayley A Hamilton
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 308C, Ottawa, ON, K1G 5Z3, Canada.
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
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Taxiarchi VP, Chew-Graham CA, Pierce M. Substantially more children receiving antidepressants see a specialist than reported by Jack et al. BMC Med 2023; 21:345. [PMID: 37691123 PMCID: PMC10494372 DOI: 10.1186/s12916-023-03043-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023] Open
Abstract
We would like to draw attention to evidence of substantial bias in the article published in this journal by Jack et al. (BMC Med 18:1-12, 2020). They provide an analysis of antidepressant prescribing to children and young people (CYP; ages 5 to 17) in primary care in England and reported that only 24.7% of CYP prescribed SSRIs for the first time were seen by a child and adolescent psychiatrist-contrary to national guidelines. We believe that their analysis is based on incomplete data that misses a large proportion of specialist mental health contacts. This is because the dataset Jack et al. used to capture specialist mental health contact-The Hospital Episode Statistics (HES) dataset-has poor coverage, as most CYP mental health services do not submit data. We demonstrate the level of underreporting with an analysis of events in a large primary care dataset where there has been a record of definite contact with CYP mental health services. We report that as many as three quarters of specialist CYP contacts with mental health specialists are missed in the HES dataset, indicating that the figure presented by Jack et al. is substantially wrong.
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Affiliation(s)
- Vicky P. Taxiarchi
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Centre for Women’s Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | | | - Matthias Pierce
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Centre for Women’s Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
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Hall KF, Korona-Bailey J, Mukhopadhyay S. Phentermine involvement in fatal drug overdoses in Tennessee, 2019-2022. Int J Drug Policy 2023; 119:104151. [PMID: 37549596 DOI: 10.1016/j.drugpo.2023.104151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/11/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION Phentermine, one of the most-commonly prescribed pharmaceuticals for weight-loss in the United States (US), has appeared on toxicology and listed as a cause of death in fatal drug overdoses in the state of Tennessee. This study aims to evaluate phentermine's involvement in fatal drug overdoses in the state of Tennessee. METHODS We used Tennessee State Unintentional Drug Overdose Reporting System (SUDORS) data and controlled substances monitoring program data (CSMD) to evaluate demographics, prescription history and co-occurring substances on toxicology in phentermine-positive cases compared with all other SUDORS cases from January 1, 2019 to June 30, 2022. A subset of these cases which listed phentermine as a cause of death was also assessed. RESULTS We identified 51 phentermine-positive cases, with a subset of 20 that listed phentermine as a cause of death. When compared to all SUDORS cases, a higher proportion of cases that listed phentermine as a cause of death were White race, females, and aged 35-44. Additionally, in all phentermine-positive cases, 41% (21) of decedents had not had a phentermine prescription dating back to 2012 and 20% (Lee et al., 1998) did not have one within the last 30 days. While there was a slight decline each year in the number of phentermine-positive cases, the number of cases that listed phentermine as a cause of death remained relatively consistent, with 95% (19) of cases having different prescriptions and/or illicit drugs listed as a cause of death along with phentermine. CONCLUSION Phentermine was listed as a cause of death in 20 fatal drug overdoses in TN. Our findings suggest there may be differences in the characteristics of these decedents when compared to all SUDORS decedents, including distribution of age, gender, and race. We also found a large presence of other prescription and illicit drugs in toxicology and cause of death along with phentermine, as well as evidence of use of the drug without a prescription. Given the lack of currently available data about non-prescribed phentermine use and its involvement in fatal drug overdoses elsewhere, a need exists to both expand surveillance capabilities and broaden research to better inform policies governing this drug in the US and internationally.
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Affiliation(s)
- Kristi F Hall
- Tennessee Department of Health, Office of Informatics and Analytics, Andrew Johnson Tower 7th Floor, 710 James Robertson Parkway, Nashville, TN 37243, United States
| | - Jessica Korona-Bailey
- Tennessee Department of Health, Office of Informatics and Analytics, Andrew Johnson Tower 7th Floor, 710 James Robertson Parkway, Nashville, TN 37243, United States
| | - Sutapa Mukhopadhyay
- Tennessee Department of Health, Office of Informatics and Analytics, Andrew Johnson Tower 7th Floor, 710 James Robertson Parkway, Nashville, TN 37243, United States
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23
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Antoñanzas F, Juárez-Castelló CA, Rodríguez-Ibeas R. Does diagnostic testing always decrease antibiotics prescriptions? Eur J Health Econ 2023; 24:673-678. [PMID: 35921019 DOI: 10.1007/s10198-022-01488-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/07/2022] [Indexed: 05/20/2023]
Abstract
BACKGROUND Empiric prescription to treat infectious diseases in community care settings has caused antibiotics to be overprescribed, increasing antimicrobial resistance (AMR). To reduce antibiotics prescription, the use of point-of-care diagnostic testing (POCT) has been suggested. METHODS We present a stylized static theoretical economic model to analyse whether the use of POCT always decreases antibiotics prescriptions. We consider the interaction of a group of doctors who differ in their level of concern about AMR when prescribing with a firm selling a POCT, and we characterize the price set by the manufacturer and doctors' decision to employ POCT. RESULTS We found that the number of antibiotics prescriptions is not always lower. This result depends on the distribution of the doctors' concern about AMR as there is a proportion of doctors who use POCT and then prescribe antibiotics while other doctors change their prescribing behaviour after using POCT and stop giving antibiotics to patients who do not benefit from them. When the proportion of patients who need antibiotic treatment is higher than the proportion of doctors who use POCT and stop prescribing unnecessary antibiotics, the number of antibiotics prescriptions is larger. Our analysis also shows that the use of POCT improves health outcomes. CONCLUSIONS We should be very careful when we assert that POCT reduces antibiotics prescriptions as there are situations in which the opposite effect occurs.
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Affiliation(s)
- F Antoñanzas
- Department of Economics, University of La Rioja, La Cigüeña 60, 26006, Logrono, Spain
| | - C A Juárez-Castelló
- Department of Economics, University of La Rioja, La Cigüeña 60, 26006, Logrono, Spain
| | - R Rodríguez-Ibeas
- Department of Economics, University of La Rioja, La Cigüeña 60, 26006, Logrono, Spain.
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Ariaga A, Balzan D, Falzon S, Sultana J. A scoping review of legibility of hand-written prescriptions and drug-orders: the writing on the wall. Expert Rev Clin Pharmacol 2023; 16:617-621. [PMID: 37308401 DOI: 10.1080/17512433.2023.2223972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Prescription and drug order writing are key components of patient care allowing physicians communicate their therapeutic plans. Although electronic prescriptions are becoming more common, handwritten prescriptions are still quite prevalent and a persistent issue with handwritten prescriptions is the illegibility of physician handwritings. Prescriptions have to be legible to avoid delays in healthcare provision and consequences as serious as patient death. AREAS COVERED We did a scoping review of multiple articles that assessed the legibility of prescriptions in different settings (inpatient, outpatient, and pharmacies) and countries, ranging from 1997 to 2020. Studies also elaborated on possible reasons for these suboptimal prescriptions and ways to address them. EXPERT OPINION While the degree of legibility of prescriptions varies widely, it remains a concern because a single incorrectly read prescription can have severe consequences. Various measures exist to possibly minimize illegible prescriptions and while none alone is probably sufficient, combining is likely to yield great results. One is the sensitization and education of physicians and physicians-in-training. Another option is audits and a third and very potent option is the use of computerized provider order entry (CPOE) system which will help improve patient safety by reducing errors due to inappropriately read prescriptions.
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Affiliation(s)
- Anderson Ariaga
- Internal Medicine Department, Vassar Brothers Medical Center, Nuvance Health Poughkeepsie, New York, NY, USA
| | - Dustin Balzan
- Pharmacy Department, Mater Dei Hospital, Msida, Malta
| | | | - Janet Sultana
- Pharmacy Department, Mater Dei Hospital, Msida, Malta
- Exeter College of Medicine and Health, Exeter University, Exeter, UK
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Gao L, Man KKC, Tse ML, Chow ATY, Wong KHTW, Chan EW, Chui CSL, Coghill D, Hon KL, Ip P, Wong ICK. Descriptive analysis of poisoning cases involving attention deficit hyperactivity disorder medications in Hong Kong. Hong Kong Med J 2023. [PMID: 37303104 DOI: 10.12809/hkmj219624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
INTRODUCTION The number of poisoning cases involving attention deficit hyperactivity disorder (ADHD) medications has reportedly risen with their increased use. However, there is limited relevant evidence from Asia. We analysed the characteristics of poisoning events involving these medications in Hong Kong. METHODS We retrieved data regarding ADHD medication-related poisoning cases from the Hong Kong Poison Information Centre and conducted a descriptive analysis of the demographic information and poisoning information including sources of cases, exposure reason, exposure location, and outcome. The HKPIC data were linked with the Hospital Authority Clinical Data Analysis and Reporting System (CDARS) via de-identified Accident and Emergency numbers of public hospitals to investigate clinical characteristics. We also retrieved ADHD medication prescription records from the CDARS, then compared trends between poisoning cases and ADHD medication use. RESULTS We identified 72 poisoning cases involving ADHD medications between 2009 and 2019, of which approximately 70% occurred in the affected individual's residence; most were intentional poisoning events (65.3%). No statistically significant association was observed between ADHD medication prescription trends and poisoning events involving ADHD medications. Of the 66 cases (91.7%) successfully linked to CDARS, 40 (60.6%) occurred in individuals with ADHD (median age: 14 years); 26 (39.4%) occurred in individuals who lacked ADHD (median age: 33 years) but displayed higher rates of other mental disorders including depression and anxiety. CONCLUSION No significant correlation was evident between ADHD medication prescriptions and poisoning events involving ADHD medications. However, medication management and caregiver education must be emphasised to prevent potential poisoning events.
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Affiliation(s)
- L Gao
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - K K C Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Centre for Medicines Optimisation Research and Education, Research Department of Policy and Practice, University College London School of Pharmacy, London, United Kingdom
| | - M L Tse
- Hong Kong Poison Information Centre, United Christian Hospital, Hong Kong SAR, China
| | - A T Y Chow
- Hong Kong Poison Information Centre, United Christian Hospital, Hong Kong SAR, China
| | - K H T W Wong
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - E W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - C S L Chui
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - D Coghill
- Department of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - K L Hon
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - P Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - I C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Centre for Medicines Optimisation Research and Education, Research Department of Policy and Practice, University College London School of Pharmacy, London, United Kingdom
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Jodar-Solà G, Brugués-Brugués A, Serra-Sutton V, Espallargues-Carreras M, Trejo-Omeñaca A, Monguet-Fierro JM. Opinion on the benefits of nurse prescribing in Catalonia. Consensus of health professionals and managers. Gac Sanit 2023; 37:102310. [PMID: 37267891 DOI: 10.1016/j.gaceta.2023.102310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To study the level of agreement among health professionals and managers in Catalonia on the benefits of nurse prescribing (NP). METHOD An online Real Time Delphi was conducted to collect the level of agreement of health professionals and managers. Participants voted in a 6-point scale (1 low benefit and 6 high benefit) for 12 items describing benefits of NP. A total of 1332 professionals participated. The level of consensus was calculated applying interquartile ranges of scores and standardized mean differences among subgroups using effect sizes (ES) and their corresponding 95% confidence intervals. RESULTS The scores indicate a general agreement on the perceived benefits of NP among participants. Standardized differences among scores on the perceived benefits among professionals were small to high (ES range between 0.2 and 1.2) between nurses and medical doctors and high between nurses and pharmacists (ES range: 1.2 and 2.4). Differences between scores of nurses and those of managers or other professionals in the present study were smaller for most voted benefits. CONCLUSIONS The study shows an agreement on the benefits of NP. Nevertheless, when standardized scores are taken into consideration, differences among professionals' perceptions emerged, and aligned with documented barriers identified in the literature such as corporative aspects, cultural limitations, institutional and organisational inertia, beliefs and unawareness of what NP implies.
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Affiliation(s)
- Glòria Jodar-Solà
- Equip d'Atenció Primària Sant Andreu Pallejà, Pallejà, Catalonia, Spain; Col·legi Oficial d'Infermeres i Infermers de Barcelona (COIB), Barcelona, Catalonia, Spain
| | - Alba Brugués-Brugués
- Consorci Castelldefels Agents de Salut (CASAP), Castelldefels (Barcelona), Catalonia, Spain; Associació d'Infermeria Familiar i Comunitària de Catalunya (AIFiCC), Barcelona, Catalonia, Spain
| | - Vicky Serra-Sutton
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Catalonia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Mireia Espallargues-Carreras
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Catalonia, Spain; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Barcelona, Spain
| | - Alex Trejo-Omeñaca
- Onsanity Solutions S.L., Barcelona, Catalonia, Spain; Universitat Politècnica de Catalunya, Escola Superior d'Enginyeria de Barcelona. Departament de Disseny, Barcelona, Catalonia, Spain
| | - Josep M Monguet-Fierro
- Universitat Politècnica de Catalunya, Escola Superior d'Enginyeria de Barcelona. Departament de Disseny, Barcelona, Catalonia, Spain
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Olden F, Dalton K. An observational study of the cause and frequency of prescription rework in community pharmacies. Int J Clin Pharm 2023:10.1007/s11096-023-01563-3. [PMID: 37160551 PMCID: PMC10169171 DOI: 10.1007/s11096-023-01563-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/20/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND When prescriptions are being processed in pharmacies, 'rework' is a phenomenon where an activity occurs that requires the return to a prior procedural step in the process for correction. To date, little is known regarding rework prevalence in community pharmacies or how this might be minimised. AIM To evaluate the cause and frequency of prescription rework in community pharmacies. METHOD A list of reworks was designed for community pharmacists to self-record prescription rework instances and causes in their workplace across a two-week period. Community pharmacists in Ireland were recruited via convenience sampling and snowballing. Descriptive statistics were used to assess rework frequency according to the various causes, as well as the pharmacist and pharmacy characteristics. RESULTS Eight pharmacists participated, recording 325 reworks across 92.9% of the 65 study days (mean 5 reworks/day). The pharmacists' mean ranged from 1.82 to 15 reworks/day. Pharmacists and pharmacy technicians alone or together were involved in 72.3% of reworks. The three most common rework categories were involving labelling errors (22.8%), prepared prescriptions which necessitated opening and repackaging (15.1%), and medication owings to patients (13.9%). CONCLUSION This study reveals that prescription rework occurs frequently in community pharmacies and has provided an indication of some of the main causes. These findings demonstrate areas where pharmacy staff can address rework and should aid the development of approaches to minimise rework in future - thus decreasing workload and facilitating more time for community pharmacy staff to focus on providing patient care.
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Affiliation(s)
- Frank Olden
- School of Pharmacy, University College Cork, College Road, Cork, Ireland
| | - Kieran Dalton
- School of Pharmacy, University College Cork, College Road, Cork, Ireland.
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Romanelli RJ, Shenoy R, Martinez MC, Mudiganti S, Mariano LT, Zanocco KA, Wagner Z, Kirkegaard A, Watkins KE. Disparities in postoperative opioid prescribing by race and ethnicity: an electronic health records-based observational study from Northern California, 2015-2020. Arch Public Health 2023; 81:83. [PMID: 37149630 PMCID: PMC10163682 DOI: 10.1186/s13690-023-01095-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 04/21/2023] [Indexed: 05/08/2023] Open
Abstract
OBJECTIVES To examine racial and ethnic disparities in postoperative opioid prescribing. DATA SOURCES Electronic health records (EHR) data across 24 hospitals from a healthcare delivery system in Northern California from January 1, 2015 to February 2, 2020 (study period). STUDY DESIGN Cross-sectional, secondary data analyses were conducted to examine differences by race and ethnicity in opioid prescribing, measured as morphine milligram equivalents (MME), among patients who underwent select, but commonly performed, surgical procedures. Linear regression models included adjustment for factors that would likely influence prescribing decisions and race and ethnicity-specific propensity weights. Opioid prescribing, overall and by race and ethnicity, was also compared to postoperative opioid guidelines. DATA EXTRACTION Data were extracted from the EHR on adult patients undergoing a procedure during the study period, discharged to home with an opioid prescription. PRINCIPAL FINDINGS Among 61,564 patients, on adjusted regression analysis, non-Hispanic Black (NHB) patients received prescriptions with higher mean MME than non-Hispanic white (NHW) patients (+ 6.4% [95% confidence interval: 4.4%, 8.3%]), whereas Hispanic and non-Hispanic Asian patients received lower mean MME (-4.2% [-5.1%, -3.2%] and - 3.6% [-4.8%, -2.3%], respectively). Nevertheless, 72.8% of all patients received prescriptions above guidelines, ranging from 71.0 to 80.3% by race and ethnicity. Disparities in prescribing were eliminated among Hispanic and NHB patients versus NHW patients when prescriptions were written within guideline recommendations. CONCLUSIONS Racial and ethnic disparities in opioid prescribing exist in the postoperative setting, yet all groups received prescriptions above guideline recommendations. Policies encouraging guideline-based prescribing may reduce disparities and overall excess prescribing.
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Affiliation(s)
| | | | - Meghan C Martinez
- Sutter Health, Center for Health Services Research-Palo Alto and Walnut Creek, Los Angeles, CA, USA
| | - Satish Mudiganti
- Sutter Health, Center for Health Services Research-Palo Alto and Walnut Creek, Los Angeles, CA, USA
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AbuHammad GAR, Naser AY, Hassouneh LKM. Diabetes mellitus-related hospital admissions and prescriptions of antidiabetic agents in England and Wales: an ecological study. BMC Endocr Disord 2023; 23:102. [PMID: 37149604 PMCID: PMC10163802 DOI: 10.1186/s12902-023-01352-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 04/25/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Around 6.5% of the population in the United Kingdom has been diagnosed with diabetes. It is associated with several long-term consequences and higher hospitalization rates. AIM To examine the profile of hospital admissions related to diabetes mellitus and the prescription rates of antidiabetic medications in England and Wales. METHOD This is an ecological study that was conducted for the period between April 1999 and April 2020 using publicly available hospitalisation data in England and Wales. Hospital admission data for patients of all ages was extracted from Hospital Episode Statistics in England and the Patient Episode Database for Wales. The difference between admission rates in 1999 and 2020, as well as the difference between diabetes mellitus medication prescription rates in 2004 and 2020, were assessed using the Pearson Chi-squared test. A Poisson regression model with robust variance estimation was used to examine the trend in hospital admissions. RESULTS A total of 1,757,892 diabetes mellitus hospital admissions were recorded in England and Wales during the duration of the study. The hospital admission rate for diabetes mellitus increased by 15.2%. This increase was concomitant with an increase in the antidiabetic medication prescribing rate of 105.9% between 2004 and 2020. Males and those in the age group of 15-59 years had a higher rate of hospital admission. The most common causes of admissions were type 1 diabetes mellitus related complications, which accounted for 47.1% of all admissions. CONCLUSION This research gives an in-depth overview of the hospitalization profile in England and Wales during the previous two decades. In England and Wales, people with all types of diabetes and related problems have been hospitalized at a high rate over the past 20 years. Male gender and middle age were significant determinants in influencing admission rates. Diabetes mellitus type 1 complications were the leading cause of hospitalizations. We advocate establishing preventative and educational campaigns to promote the best standards of care for individuals with diabetes in order to lower the risk of diabetes-related complications.
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Affiliation(s)
- Gayda Abdel Rahman AbuHammad
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
| | - Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan.
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Wang Y, Xu J, Zhang J, Xu H, Sun Y, Miao Y, Wen T. SIAP: an intelligent algorithm for multiple prescription pattern recognition based on weighted similarity distances. BMC Med Inform Decis Mak 2023; 23:79. [PMID: 37143043 PMCID: PMC10157906 DOI: 10.1186/s12911-023-02141-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 03/10/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Clinical practices have demonstrated that disease treatment can be very complex. Patients with chronic diseases often suffer from more than one disease. Complex diseases are often treated with a variety of drugs, including both primary and auxiliary treatments. This complexity and multidimensionality increase the difficulty of extracting knowledge from clinical data. METHODS In this study, we proposed a subgroup identification algorithm for complex prescriptions (SIAP). We applied the SIAP algorithm to identify the importance level of each drug in complex prescriptions. The algorithm quickly classified and determined valid prescription combinations for patients. The algorithm was validated through classification matching of classical prescriptions in traditional Chinese medicine. We collected 376 formulas and their compositions from a formulary to construct a database of standard prescriptions. We also collected 1438 herbal prescriptions from clinical data for automated prescription identification. The prescriptions were divided into training and test sets. Finally, the parameters of the two sub-algorithms of SIAP and SIAP-All, as well as those of the combination algorithm SIAP + All, were optimized on the training set. A comparison analysis was performed against the baseline intersection set rate (ISR) algorithm. The algorithm for this study was implemented with Python 3.6. RESULTS The SIAP-All and SIAP + All algorithms outperformed the benchmark ISR algorithm in terms of accuracy, recall, and F1 value. The F1 values were 0.7568 for SIAP-All and 0.7799 for SIAP + All, showing improvements of 8.73% and 11.04% over the existing ISR algorithm, respectively. CONCLUSION We developed an algorithm, SIAP, to automatically match sub-prescriptions of complex drugs with corresponding standard or classic prescriptions. The matching algorithm weights the drugs in the prescription according to their importance level. The results of this study can help to classify and analyse the drug compositions of complex prescriptions.
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Affiliation(s)
- Yifei Wang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, China
| | - Julia Xu
- The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Jie Zhang
- Institute of Information Engineering, Chinese Academy of Sciences, Beijing, 100085, China
| | - Hong Xu
- College of Engineering and Science, Victoria University, Melbourne, VIC, 3000, Australia
| | - Yuzhong Sun
- Institute of Computing Technology, Chinese Academy of Sciences, Beijing, 100080, China
| | - Yuan Miao
- College of Engineering and Science, Victoria University, Melbourne, VIC, 3000, Australia.
| | - Tiancai Wen
- Data Center of Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
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Okuda S, Qureshi ZP, Yanagida Y, Ito C, Homma Y, Tokita S. Hypnotic prescription trends and patterns for the treatment of insomnia in Japan: analysis of a nationwide Japanese claims database. BMC Psychiatry 2023; 23:278. [PMID: 37081408 PMCID: PMC10120113 DOI: 10.1186/s12888-023-04683-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 03/14/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND There is limited consensus regarding the optimal treatment of insomnia. The recent introduction of orexin receptor antagonists (ORA) has increased the available treatment options. However, the prescribing patterns of hypnotics in Japan have not been comprehensively assessed. We performed analyses of a claims database to investigate the real-world use of hypnotics for treating insomnia in Japan. METHODS Data were retrieved for outpatients (aged ≥ 20 to < 75 years old) prescribed ≥ 1 hypnotic for a diagnosis of insomnia between April 1st, 2009 and March 31st, 2020, with ≥ 12 months of continuous enrolment in the JMDC Claims Database. Patients were classified as new or long-term users of hypnotics. Long-term use was defined as prescription of the same mechanism of action (MOA) for ≥ 180 days. We analyzed the trends (2010-2019) and patterns (2018-2019) in hypnotics prescriptions. RESULTS We analyzed data for 130,177 new and 91,215 long-term users (2010-2019). Most new users were prescribed one MOA per year (97.1%-97.9%). In 2010, GABAA-receptor agonists (benzodiazepines [BZD] or z-drugs) were prescribed to 94.0% of new users. Prescriptions for BZD declined from 54.8% of patients in 2010 to 30.5% in 2019, whereas z-drug prescriptions remained stable (~ 40%). Prescriptions for melatonin receptor agonist increased slightly (3.2% to 6.3%). Prescriptions for ORA increased over this time from 0% to 20.2%. Prescriptions for BZD alone among long-term users decreased steadily from 68.3% in 2010 to 49.7% in 2019. Prescriptions for ORA were lower among long-term users (0% in 2010, 4.3% in 2019) relative to new users. Using data from 2018-2019, multiple (≥ 2) MOAs were prescribed to a higher proportion of long-term (18.2%) than new (2.8%) users. The distribution of MOAs according to psychiatric comorbidities, segmented by age or sex, revealed higher proportions of BZD prescriptions in elderly (new and long-term users) and male (new users) patients in all comorbidity segments. CONCLUSION Prescriptions for hypnotics among new and long-term users in Japan showed distinct patterns and trends. Further understanding of the treatment options for insomnia with accumulating evidence for the risk-benefit balance might be beneficial for physicians prescribing hypnotics in real-world settings.
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Affiliation(s)
| | - Zaina P Qureshi
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, USA
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Guettabi M, Witman A. Universal cash transfers and prescription utilization: Evidence from the Alaska permanent fund dividend. J Health Econ 2023; 90:102758. [PMID: 37146407 DOI: 10.1016/j.jhealeco.2023.102758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/13/2023] [Accepted: 04/09/2023] [Indexed: 05/07/2023]
Abstract
We investigate the impact of a large cash transfer on prescription utilization. Our identification strategy leverages the Alaksa Permanent Fund Dividend (PFD), which is distributed annually in October and comprises 6% of the average household's annual income. We study the impact of the PFD on the use of prescription medications using a within-Alaska comparison group and difference-in-differences design. Using the IBM MarketScan Commercial Claims and Encounters Prescription Drug Database, we observe prescriptions for 50,866 commercially-insured individuals who filled prescriptions between 2013 and 2019. We find no changes in prescription use overall and are able to rule out changes larger than 0.5% in the week of the PFD and 1.4% the week after. Subgroup analyses find no changes by patient characteristics, degree of cost sharing, or prescription type. We also conduct a synthetic control analysis using a non-Alaska comparison group and find no effects of the PFD on prescriptions. These findings are useful for understanding liquidity sensitivity for prescription medication and the effects of cash distributions among individuals with employer-based health insurance.
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Affiliation(s)
| | - Allison Witman
- University of North Carolina, Wilmington, United States.
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Ramdin C, Bikkina R, Nelson L, Mazer-Amirshahi M. Trends in amphetamine prescriptions given at discharge in emergency departments: A national analysis (2012-2019). Am J Emerg Med 2023; 66:91-97. [PMID: 36738570 DOI: 10.1016/j.ajem.2023.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/09/2023] [Accepted: 01/24/2023] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES In parallel with the opioid epidemic, there has been a resurgence in abuse, medical complications, and deaths related to amphetamines. The opioid epidemic began with increasing rates of prescription products that evolved overtime to include heroin and more recently, fentanyl analogues. Current trends in amphetamine prescriptions are less well described. We sought to determine if there has been a change in amphetamine prescriptions given at discharge in U.S. emergency departments (EDs) in recent years. METHODS We conducted a retrospective review of data provided by the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2012 to 2019. We computed total number of visits that were given amphetamine prescriptions (amphetamine salts, methylphenidate derivatives, and dexmethylphenidate) at discharge for each year. We computed the total number and rate of visits (of all ED visits) that had both amphetamines and opioids prescribed at discharge over the years. We computed data normality using Shapiro Wilke's test and used descriptive statistics such as mean to describe the data distribution as applicable. We used spearman's rho (SR) or pearson's correlation (PC) as applicable to describe trends in data. All p-values were one-tailed and were reported at a 0.05 significance level. All analyses were conducted in IBM SPSS version 28. RESULTS/FINDINGS From 2012 to 2019, there were an estimated 817,895 ED visits where an amphetamine prescription was given at discharge, with an overall strong increase in rate over time (SR = 0.71, p = 0.02). At the beginning of the study period (2012) there were 83,503 (0.06%) visits and in 2019 there were 186,539 (0.12%) visits (123% absolute increase). On average, there were 102,237 (SD: 52,725) visits with discharge amphetamine prescriptions per year. There was a strong, linear increase in number of visits that involved a discharge amphetamine salt prescription (PC = 0.92, p = 0.001). In 2012, there were a total of 23,676 visits and in 2019, a total of 124,773 visits (427% increase). There was no trend in visits where both an amphetamine and opioid were prescribed (PC: 0.61, p = 0.06). CONCLUSION There have been increases in discharge prescriptions for amphetamines in the ED over time. This was largely driven by prescriptions for amphetamine salts. Future research initiatives should continue to monitor this trend and in prescriptions and associated abuse in the setting of rising amphetamine abuse.
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Affiliation(s)
- Christine Ramdin
- Rutgers New Jersey Medical School, Department of Emergency Medicine, United States of America.
| | - Rama Bikkina
- Georgetown University, School of Medicine, United States of America
| | - Lewis Nelson
- Rutgers New Jersey Medical School, Department of Emergency Medicine, United States of America
| | - Maryann Mazer-Amirshahi
- Georgetown University, School of Medicine, United States of America; Department of Emergency Medicine, MedStar Washington Hospital Center, United States of America
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Amsallem A, Berthou-Contreras J, Joret N, Koeberlé S, Limat S, Clairet AL. [ Prescriptions of statins in the elderly according to the type of healthcare establishment: An example of the usefulness of territorial hospital groups]. Ann Pharm Fr 2023; 81:346-353. [PMID: 35728628 DOI: 10.1016/j.pharma.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The challenge of territorial hospital groups is to develop coherent care pathways for optimal patient care. Following the creation of a territorial pharmaceutical team, a common prescription review process was initiated in our health area. The objective of this study is to analyze the uses of statins in the elderly. METHOD The study included all statin-treated patients older than 75 years at the five participating institutions (including long-term nursing homes). In a prospective multicenter study, the benefit/risk ratio of statin prescription has been assessed up. Depending on the clinical situation, a proposal to stop or adjust the dosage could be made. RESULTS Nine hundred and forty-seven patients were included. Among them, 184 were treated with a statin. Forty-seven patients (26%) are treated in primary prevention and 137 patients (74%) in secondary prevention. Dosages are lower for long stays. Fifteen treatments interruption were accepted out of 44 proposals, mostly for long stays. The reasons given to continue treatment are the need for a new evaluation by a cardiologist or a high cardiovascular risk. CONCLUSION The variability of results according to the type healthcare institution makes territorial medical and pharmaceutical collaboration relevant. The challenge is to develop a coherent care pathway for optimal care of elderly patients, with congruent objectives.
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Affiliation(s)
- A Amsallem
- Pôle pharmaceutique, CHRU Jean-Minjoz, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France
| | - J Berthou-Contreras
- Pôle pharmaceutique, CHRU Jean-Minjoz, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France
| | - N Joret
- Pôle pharmaceutique, CHRU Jean-Minjoz, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France
| | - S Koeberlé
- Service de court séjour gériatrique, CHRU Jean-Minjoz, Besançon, France; Équipe « Éthique et progrès médical », Inserm, CIC 1431, université Bourgogne Franche-Comté, Besançon, France
| | - S Limat
- Pôle pharmaceutique, CHRU Jean-Minjoz, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France; Inserm, EFS BFC, UMR 1098, université de Bourgogne Franche-Comté, Besançon, France
| | - A-L Clairet
- Pôle pharmaceutique, CHRU Jean-Minjoz, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France; Inserm, EFS BFC, UMR 1098, université de Bourgogne Franche-Comté, Besançon, France.
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García Diez S, De Nicolás Valdés M, Diéguez Varela C, Fernández Martínez P, Suárez Gil P, Navarro Rodríguez Y. [Impact of COVID-19 lockdown on the prescription of benzodiazepines]. Aten Primaria 2023; 55:102552. [PMID: 36599201 DOI: 10.1016/j.aprim.2022.102552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate the effect of COVID-19 lockdown on the prescription of benzodiazepines by gender, age and district health departments. DESIGN Longitudinal observational study. LOCATION Primary care. Asturias (Spain) health district V. PARTICIPANTS People over 15 years of age with filled benzodiazepine prescriptions in between 2017 and 2020. MAIN MEASUREMENTS Benzodiazepine DHD (defined daily dose per 1000 habitants) mean difference between the period defined as pre-lockdown and lockdown. Additionally, the difference was adjusted for gender, sex and district health department and also with the interaction among them. RESULTS DHD mean pre-lockdown was 131.3 and 139.5 in the lockdown; this difference was significant in the global analysis (95% CI: 4.1-12.1). There was an increase in the DHD mean in the 60-74 age group (95% CI: 2.28-21.42), in the group over 90 years old (95% CI: 21.31-40.63) and in women (95% CI: 3.51-14.59). Finally, a decrease in the DHD mean of V11 (95% CI: -29 to -0.66) and V14 (95% CI: -54.28 to -25.04) district health departments was observed. CONCLUSIONS Certain subgroups show a change in the pattern of benzodiazepine prescription without being able to relate this to the lockdown. We believe that there could be some inertia in the prescription of psychiatric medication according to the biopsychosocial characteristics of the patients; it is important to detect this in order to avoid the medicalization of psychological disorders.
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Rismiati H, Lee KS, Kang J, Cho HJ, Lee HY. The role of discharge checklist in guideline-directed medical therapy for heart failure patients. Korean J Intern Med 2023; 38:195-206. [PMID: 36800678 PMCID: PMC9993090 DOI: 10.3904/kjim.2022.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/17/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND/AIMS Initiation of guideline-directed medical therapy (GDMT) during hospitalization is recommended for patients with heart failure (HF). However, GDMT is underutilized in real-world practice. This study evaluated the role of a discharge checklist on GDMT. METHODS This was a single-center, observational study. The study included all patients hospitalized for HF between 2021 and 2022. The clinical data were retrieved from the electronic medical records and discharge checklist published by the Korean Society of Heart Failure. The adequacy of GDMT prescriptions was evaluated in three ways: the total number of GDMT drug classes and two types of adequacy scores. The primary endpoint was the incidence of all-cause mortality or rehospitalization due to HF within 2 months of discharge. RESULTS Overall, the checklist was completed by 244 patients (checklist group) and was not completed in 171 patients (non-checklist group). The baseline characteristics were comparable between two groups. At discharge, a higher proportion of patients in the checklist group received GDMT than in the non-checklist group (67.6% vs. 50.9%, p = 0.001). The incidence of primary endpoint was lower in the checklist group compared to the non-checklist group (5.3% vs. 11.7%, p = 0.018). The use of the discharge checklist was associated with significantly lower risk of death and rehospitalization in the multivariable analysis (hazard ratio, 0.45; 95% confidence interval, 0.23-0.92; p = 0.028). CONCLUSION Discharge checklist usage is a simple but effective strategy for GDMT initiation during hospitalization. The discharge checklist was associated with better outcome in patients with HF.
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Affiliation(s)
- Helsi Rismiati
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Kyu-Sun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Jeehoon Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
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Simon M, Pereira O, Constant ML, Guillet-Thibault J, Pulcini C, Thilly N. Characteristics of dentists and patients associated with appropriate antibiotic prescriptions by French dentists: a cross-sectional study using Health Insurance databases. BMC Oral Health 2023; 23:29. [PMID: 36653760 PMCID: PMC9846701 DOI: 10.1186/s12903-023-02727-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The use of antibiotics in dental care is often unnecessary or inappropriate. Our objectives were to identify (i) Clusters of dentists grouped according to their appropriateness score based on proxy indicators' results; and (ii) Dentists' and patients' characteristics associated with the appropriateness of antibiotic prescriptions. METHODS We used data of the Health Insurance reimbursement databases on antibiotics prescribed in 2019 by general dental practitioners of the Grand Est region in France. The appropriateness of antibiotic prescriptions was estimated by the results of recently published proxy indicators. We conducted a cluster analysis according to an appropriateness score calculated for each dentist, using the Ward method. We then conducted bivariate and multivariable analyses to identify characteristics associated with these clusters. RESULTS We included 3,014 dentists, who prescribed 373,975 antibiotics in 2019, and which were grouped into three clusters: average practices (n = 1,241), better (n = 686), and worse (n = 1,087) than average practices. Overall, dentists had more appropriate prescription practices when they were male (OR for belonging to cluster with "worse than average practices" = 1.37 (p = 0.003) for female), having a predominant surgery practice (p = 0.028) in the Lorraine area (p < 0.0001) for less years (p = 0.0002), when they had healthier patients (i.e., younger, with no chronic diseases, and who received less procedures), and when they had a more prudent use of drugs in general (i.e., less prescriptions of drugs, antibiotics, and non-steroidal anti-inflammatory). CONCLUSIONS We identified clusters and characteristics associated with the appropriateness of antibiotic prescriptions made by dentists, which might help guiding antimicrobial stewardship interventions.
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Affiliation(s)
- Maïa Simon
- grid.29172.3f0000 0001 2194 6418Université de Lorraine, APEMAC, Nancy, France ,grid.410527.50000 0004 1765 1301Université de Lorraine, CHRU de Nancy, Département Méthodologie Promotion Investigation, F-54000 Nancy, France
| | - Ouarda Pereira
- Direction Régionale du Service Médical (DRSM) Grand Est, Strasbourg, France
| | - Marie-Louise Constant
- grid.410527.50000 0004 1765 1301Université de Lorraine, CHRU de Nancy, Service d’Odontologie, F-54000 Nancy, France
| | - Julie Guillet-Thibault
- grid.410527.50000 0004 1765 1301Université de Lorraine, CHRU de Nancy, Service d’Odontologie, F-54000 Nancy, France
| | - Céline Pulcini
- grid.29172.3f0000 0001 2194 6418Université de Lorraine, APEMAC, Nancy, France ,grid.410527.50000 0004 1765 1301Université de Lorraine, CHRU de Nancy, Département de Maladies Infectieuses, F-54000 Nancy, France
| | - Nathalie Thilly
- grid.29172.3f0000 0001 2194 6418Université de Lorraine, APEMAC, Nancy, France ,grid.410527.50000 0004 1765 1301Université de Lorraine, CHRU de Nancy, Département Méthodologie Promotion Investigation, F-54000 Nancy, France
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Subramanian A, Azcoaga-Lorenzo A, Anand A, Phillips K, Lee SI, Cockburn N, Fagbamigbe AF, Damase-Michel C, Yau C, McCowan C, O'Reilly D, Santorelli G, Hope H, Kennedy JI, Abel KM, Eastwood KA, Locock L, Black M, Loane M, Moss N, Plachcinski R, Thangaratinam S, Brophy S, Agrawal U, Vowles Z, Brocklehurst P, Dolk H, Nelson-Piercy C, Nirantharakumar K. Polypharmacy during pregnancy and associated risk factors: a retrospective analysis of 577 medication exposures among 1.5 million pregnancies in the UK, 2000-2019. BMC Med 2023; 21:21. [PMID: 36647047 PMCID: PMC9843951 DOI: 10.1186/s12916-022-02722-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The number of medications prescribed during pregnancy has increased over the past few decades. Few studies have described the prevalence of multiple medication use among pregnant women. This study aims to describe the overall prevalence over the last two decades among all pregnant women and those with multimorbidity and to identify risk factors for polypharmacy in pregnancy. METHODS A retrospective cohort study was conducted between 2000 and 2019 using the Clinical Practice Research Datalink (CPRD) pregnancy register. Prescription records for 577 medication categories were obtained. Prevalence estimates for polypharmacy (ranging from 2+ to 11+ medications) were presented along with the medications commonly prescribed individually and in pairs during the first trimester and the entire pregnancy period. Logistic regression models were performed to identify risk factors for polypharmacy. RESULTS During the first trimester (812,354 pregnancies), the prevalence of polypharmacy ranged from 24.6% (2+ medications) to 0.1% (11+ medications). During the entire pregnancy period (774,247 pregnancies), the prevalence ranged from 58.7 to 1.4%. Broad-spectrum penicillin (6.6%), compound analgesics (4.5%) and treatment of candidiasis (4.3%) were commonly prescribed. Pairs of medication prescribed to manage different long-term conditions commonly included selective beta 2 agonists or selective serotonin re-uptake inhibitors (SSRIs). Risk factors for being prescribed 2+ medications during the first trimester of pregnancy include being overweight or obese [aOR: 1.16 (1.14-1.18) and 1.55 (1.53-1.57)], belonging to an ethnic minority group [aOR: 2.40 (2.33-2.47), 1.71 (1.65-1.76), 1.41 (1.35-1.47) and 1.39 (1.30-1.49) among women from South Asian, Black, other and mixed ethnicities compared to white women] and smoking or previously smoking [aOR: 1.19 (1.18-1.20) and 1.05 (1.03-1.06)]. Higher and lower age, higher gravidity, increasing number of comorbidities and increasing level of deprivation were also associated with increased odds of polypharmacy. CONCLUSIONS The prevalence of polypharmacy during pregnancy has increased over the past two decades and is particularly high in younger and older women; women with high BMI, smokers and ex-smokers; and women with multimorbidity, higher gravidity and higher levels of deprivation. Well-conducted pharmaco-epidemiological research is needed to understand the effects of multiple medication use on the developing foetus.
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Affiliation(s)
- Anuradhaa Subramanian
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Amaya Azcoaga-Lorenzo
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Astha Anand
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Neil Cockburn
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Adeniyi Francis Fagbamigbe
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Christine Damase-Michel
- Medical and Clinical Pharmacology, School of Medicine, Université Toulouse III, Toulouse, France
- INSERM, Center for Epidemiology and Research in Population Health (CERPOP), Toulouse, CIC 1436, France
| | - Christopher Yau
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- Health Data Research UK, Oxford, UK
| | - Colin McCowan
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | | | - Holly Hope
- Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
| | | | - Kathryn M Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kelly-Ann Eastwood
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
- St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Louise Locock
- Health Services Research Unit, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Mairead Black
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Maria Loane
- Centre for Maternal, Fetal and Infant Research, The Institute of Nursing and Health Research, Ulster University, Coleraine, UK
| | - Ngawai Moss
- Patient and Public Representative, London, UK
| | | | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Sinead Brophy
- Data Science, Medical School, Swansea University, Swansea, UK
| | - Utkarsh Agrawal
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Zoe Vowles
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Peter Brocklehurst
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Helen Dolk
- Centre for Maternal, Fetal and Infant Research, The Institute of Nursing and Health Research, Ulster University, Coleraine, UK
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Dave AD, Falcone M. Opioid prescribing patterns among oculofacial plastic surgeons. Int Ophthalmol 2023; 43:167-174. [PMID: 35867311 DOI: 10.1007/s10792-022-02413-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/15/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Oculofacial plastic surgeons (OPS) prescribe narcotic pain prescriptions at a rate four times higher than that of other ophthalmologists. We conducted a cross-sectional survey to understand trends in opioid prescriptions among oculofacial plastic surgeons after common oculoplastic surgeries. METHODS This cross-sectional survey was sent to OPS in the USA between June 19, 2020 and December 1, 2020. Participants were asked about their training and practice as well as their top two choices for post-operative pain management both overall and for seven common oculoplastic surgeries. Fisher's exact and chi-square tests were performed to analyze relationships between categorical variables. RESULTS The two most common opioid medications, in percentage of respondents (n = 82), prescribed overall by OPS were hydrocodone-acetaminophen (35%) and tramadol (21%). Between OPS completed training before 1990 (16%) and those who completed training from 1991 to 2000 (12%), the latter cohort is 4.9 times more likely to prescribe opioids overall ([95% CI = 1.3-15.4], p = .01). Additionally, OPS who are currently practicing in the Southeast USA are 4.2 times more likely to prescribe opioids overall than those practicing in the Northeast USA ([95% CI: 1.4-12.8], p = .02). CONCLUSION This study has helped identify patterns in opioid prescribing behavior among OPS based on demographic information and common oculoplastic surgeries. This knowledge will help bring awareness of prescribing behavior to the oculoplastics community and identify areas of improvement to reduce opioid prescriptions. Kindly check and confirm the OD and ON has been correctly identified in 2nd affiliationYes.
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Affiliation(s)
- Amisha D Dave
- University of Connecticut School of Medicine, Farmington, CT, USA
- Department of Ophthalmology, UConn Health, Outpatient Pavilion, 5th Floor, 135 Dowling Way, Farmington, CT, 06030, USA
| | - Madina Falcone
- Department of Ophthalmology, UConn Health, Outpatient Pavilion, 5th Floor, 135 Dowling Way, Farmington, CT, 06030, USA.
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Maierhofer CN, Ranapurwala SI, DiPrete BL, Fulcher N, Ringwalt CL, Chelminski PR, Ives TJ, Dasgupta N, Go VF, Pence BW. Intended and unintended consequences: Changes in opioid prescribing practices for postsurgical, acute, and chronic pain indications following two policies in North Carolina, 2012-2018 - Controlled and single-series interrupted time series analyses. Drug Alcohol Depend 2023; 242:109727. [PMID: 36516549 PMCID: PMC9801483 DOI: 10.1016/j.drugalcdep.2022.109727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The potential misapplication of current opioid prescribing policies remains understudied and may have substantial adverse implications for patient safety. METHODS We used autoregressive integrated moving average models to assess level and trend changes in monthly 1) prescribing rates, 2) days' supply, and 3) daily morphine milligram equivalents (MME) of incident opioid prescriptions relative to 1) a state medical board initiative to reduce high-dose and -volume opioid prescribing and 2) legislation to limit initial opioid prescriptions for acute and postsurgical pain. We examined outcomes by pain indication overall and by cancer history, using prescribing patterns for benzodiazepines to control for temporal trends. We used large private health insurance claims data to include North Carolina residents, aged 18-64, insured at any point between January 2012 and August 2018. RESULTS After the medical board initiative, prescribing patterns for chronic pain patients did not change; conversely, acute and postsurgical pain patients experienced immediate declines in daily MME. Post-legislation prescription rates did not decline for those with acute, postsurgical, and non-cancer pain, but instead declined among cancer patients with chronic pain. Chronic pain patients experienced the largest days' supply declines post-legislation, instead of acute and postsurgical pain patients. CONCLUSIONS We found mixed evidence on the potential impact of two opioid prescribing policies, with some observed declines in a group not intended to be impacted by the policy. This study provides evidence of the need for clearer opioid prescribing policies to ensure impacts on intended populations and avoid unintended consequences.
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Affiliation(s)
- Courtney N Maierhofer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC 27599, USA.
| | - Shabbar I Ranapurwala
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC 27599, USA; Injury Prevention Research Center, University of North Carolina, 521S Greensboro St, Carrboro, NC 27510, USA.
| | - Bethany L DiPrete
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC 27599, USA; Injury Prevention Research Center, University of North Carolina, 521S Greensboro St, Carrboro, NC 27510, USA.
| | - Naoko Fulcher
- Injury Prevention Research Center, University of North Carolina, 521S Greensboro St, Carrboro, NC 27510, USA.
| | - Christopher L Ringwalt
- Injury Prevention Research Center, University of North Carolina, 521S Greensboro St, Carrboro, NC 27510, USA; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC 27599, USA.
| | - Paul R Chelminski
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, 321S. Columbia Street, Chapel Hill, NC 27599, USA.
| | - Timothy J Ives
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, 321S. Columbia Street, Chapel Hill, NC 27599, USA; Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, 301 Pharmacy Ln, Chapel Hill, NC 27599, USA.
| | - Nabarun Dasgupta
- Injury Prevention Research Center, University of North Carolina, 521S Greensboro St, Carrboro, NC 27510, USA.
| | - Vivian F Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC 27599, USA.
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC 27599, USA.
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Heo E, Choi Y, Kim HS, Namgung HW, Lee E, Lee E, Lee JY, Jung J, Kim ES, Kim HB, Song KH. Current Status of Outpatient Parenteral Antimicrobial Therapy in Korea: Experience of a Single University-Affiliated Acute-Care Hospital. Infect Chemother 2022:54.e89. [PMID: 36603822 DOI: 10.3947/ic.2022.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/02/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Systematic protocols for the management of outpatient parenteral antimicrobial therapy (OPAT) and information on the current status of a prescription of parenteral antibiotics for outpatients and referred patients are lacking in the Republic of Korea. This study aimed to describe the current status of OPAT at a tertiary care hospital in Korea. MATERIALS AND METHODS This was a retrospective study of outpatients and referral patients who were prescribed parenteral antibiotics from July to December 2019. We reviewed the prescribed antimicrobials, indications for antimicrobial therapy, institution administering the antimicrobial injections, and pre- and post-prescription management. RESULTS Of the 577 prescriptions assessed in this study, 399 (69.2%) and 178 (30.8%) were delivered using the referral and outpatient models, respectively. About 70% of OPATs were prescribed in the pulmonology, infectious diseases, orthopedics, gastroenterology, and hematology departments. Five antibiotics (ertapenem [26.0%], ceftriaxone [12.8%], kanamycin [11.8%], amikacin [10.1%], and cefazolin [8.5%]) accounted for 69.2% of the total OPATs. Urinary tract (27.3%), respiratory (20.8%), and intra-abdominal (15.9%) infections were the most frequent indications for OPAT. After prescription, there were 295 (73.9%) and 150 (84.3%) follow-up visits in the referral and outpatient models, respectively (P <0.05). Laboratory tests necessary for monitoring were fully performed for 274 (47.5%) prescriptions. CONCLUSION We found that a significant number of OPATs were prescribed, follow-up visits were not performed in the case of about a quarter of prescriptions, and laboratory monitoring was not fully conducted in more than half of the cases. Therefore, it is necessary to establish an appropriate management program for OPAT. Considering the limited resources and the distribution of OPAT prescriptions, an effective strategy may be to select the frequently-used antibiotics or frequently-prescribing departments and start the program with them.
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Affiliation(s)
- Eunjeong Heo
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoonhee Choi
- Department of Pharmacy, Yeungnam University Medical Center, Daegu, Korea
| | - Hyung-Sook Kim
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyung Wook Namgung
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eunsook Lee
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Euni Lee
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Korea
| | - Ju-Yeun Lee
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Korea
| | - Jongtak Jung
- Department of Internal Medicine, Soon Chun Hyang University Hospital Seoul, Seoul National University College of Medicine, Seoul, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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Tanaka R, Watanabe S. Skin disinfection using hygiene swabs for self-injection of diabetes medications: an overview of the current best practices. Diabetol Int 2022; 14:115-116. [PMID: 36540860 PMCID: PMC9754986 DOI: 10.1007/s13340-022-00615-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
Injectable diabetes medications are widely available. Although self-injection techniques update with the release of new devices, current clinical practices in Japan consistently adhere to the standardized hygiene procedures for skin disinfection. On the other hand, the manual for disaster diabetes care does not require the victims to skin preparation using alcohol swabs before injection. The World Health Organization shows that skin disinfection with alcohol is not necessary for subcutaneous injections, and that hand hygiene and skin preparation with soap and water are important procedures. Skin preparation for self-injection remains controversial. Thus, this article overviewed current best practices and discussed future implementation of skin preparation for self-injection of diabetes medications. According to the latest published studies, there is a trade-off between standardized infection control and cost-saving. To address the practical debate, revision of the best practices for self-injection techniques stratified by healthcare setting, cost-effectiveness analysis based on patient-reported outcomes, and opt-in prescribing systems are needed.
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Affiliation(s)
- Rie Tanaka
- Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki Japan
| | - Shinobu Watanabe
- Department of Nursing, School of Health Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki, Japan
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Hansen AB, Baste V, Hetlevik Ø, Smith-Sivertsen T, Haukenes I, de Beurs D, Nielen M, Ruths S. Comparison of depression care provided in general practice in Norway and the Netherlands: registry-based cohort study (The Norwegian GP-DEP study). BMC Health Serv Res 2022; 22:1494. [PMID: 36476615 PMCID: PMC9730606 DOI: 10.1186/s12913-022-08793-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/06/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Depression is highly prevalent in general practice, and organisation of primary health care probably affects the provision of depression care. General practitioners (GPs) in Norway and the Netherlands fulfil comparable roles. However, primary care teams with a mental health nurse (MHN) supplementing the GP have been established in the Netherlands, but not yet in Norway. In order to explore how the organisation of primary mental care affects care delivery, we aimed to examine the provision of GP depression care across the two countries. METHODS Registry-based cohort study comprising new depression episodes in patients aged ≥ 18 years, 2011-2015. The Norwegian sample was drawn from the entire population (national health registries); 297,409 episodes. A representative Dutch sample (Nivel Primary Care Database) was included; 27,362 episodes. Outcomes were follow-up consultation(s) with GP, with GP and/or MHN, and antidepressant prescriptions during 12 months from the start of the depression episode. Differences between countries were estimated using negative binomial and Cox regression models, adjusted for patient gender, age and comorbidity. RESULTS Patients in the Netherlands compared to Norway were less likely to receive GP follow-up consultations, IRR (incidence rate ratio) = 0.73 (95% confidence interval (CI) 0.71-0.74). Differences were greatest among patients aged 18-39 years (adj IRR = 0.64, 0.63-0.66) and 40-59 years (adj IRR = 0.71, 0.69-0.73). When comparing follow-up consultations in GP practices, including MHN consultations in the Netherlands, no cross-national differences were found (IRR = 1.00, 0.98-1.01). But in age-stratified analyses, Dutch patients 60 years and older were more likely to be followed up than their Norwegian counterparts (adj IRR = 1.21, 1.16-1.26). Patients in the Netherlands compared to Norway were more likely to receive antidepressant drugs, adj HR (hazard ratio) = 1.32 (1.30-1.34). CONCLUSIONS The observed differences indicate that the organisation of primary mental health care affects the provision of follow-up consultations in Norway and the Netherlands. Clinical studies are needed to explore the impact of team-based care and GP-based care on the quality of depression care and patient outcomes.
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Affiliation(s)
- Anneli Borge Hansen
- grid.509009.5Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Valborg Baste
- grid.509009.5Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Øystein Hetlevik
- grid.509009.5Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Tone Smith-Sivertsen
- grid.509009.5Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Inger Haukenes
- grid.509009.5Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Derek de Beurs
- grid.416017.50000 0001 0835 8259Department of Mental Health and Prevention, Trimbos Institute, Utrecht, The Netherlands
| | - Mark Nielen
- grid.416005.60000 0001 0681 4687Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Sabine Ruths
- grid.509009.5Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Robijn AL, Woodward M, Pearson SA, Hsu B, Chow CK, Filion KB, Jorm L, Havard A. Uptake of prescription smoking cessation pharmacotherapies after hospitalization for major cardiovascular disease. Eur J Prev Cardiol 2022; 29:2173-2182. [PMID: 35950363 DOI: 10.1093/eurjpc/zwac172] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 01/11/2023]
Abstract
AIMS We determined the prevalence of prescription smoking cessation pharmacotherapy (SCP) use after hospitalization for major cardiovascular disease (MCD) among people who smoke and whether this varies by sex. METHODS AND RESULTS We conducted a population-based cohort study including all people hospitalized in New South Wales, Australia, between July 2013 and December 2018 (2017 for private hospitals) with an MCD diagnosis. For patients who also had a diagnosis of current tobacco use, we used linked pharmaceutical dispensing records to identify prescription SCP dispensings within 90 days post-discharge. We determined the proportion who were dispensed an SCP within 90 days, overall and by type of SCP. We used logistic regression to estimate the odds of females being dispensed an SCP relative to males. Of the 150 758 patients hospitalized for an MCD, 20 162 (13.4%) had a current tobacco use diagnosis, 31% of whom were female. Of these, 11.3% (12.4% of females, 10.9% of males) received prescription SCP within 90 days post-discharge; 3.0% were dispensed varenicline, and 8.3% were dispensed nicotine replacement therapy patches. Females were more likely than males to be dispensed a prescription SCP [odds ratio (OR) 1.16, 95% confidence interval (CI) 1.06-1.27)]; however, this was not maintained after adjusting for potential confounders (adjusted OR 1.04, 95% CI 0.94-1.15). CONCLUSION Very few females and males who smoke use prescription SCPs after hospitalization for an MCD. The use of varenicline, the SCP with the highest efficacy, was particularly low. This represents a missed opportunity to increase smoking cessation in this high-risk population, thereby reducing their risk of recurrent cardiovascular events.
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Affiliation(s)
- Annelies L Robijn
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-42 King Street, Randwick NSW 2031, Australia.,Centre for Big Data Research in Health, UNSW Sydney, Australia Level 2, G27 Botany Street, Kensington NSW 2052, Australia
| | - Mark Woodward
- The George Institute for Global Health, UNSW Sydney, Australia Level 5, 1 King Street, Newtown NSW 2042, Australia.,The George Institute for Global Health, School of Public Health, Imperial College London, 84 Wood Lane, London W12 0BZ, UK
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, UNSW Sydney, Australia Level 2, G27 Botany Street, Kensington NSW 2052, Australia
| | - Benjumin Hsu
- Centre for Big Data Research in Health, UNSW Sydney, Australia Level 2, G27 Botany Street, Kensington NSW 2052, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Australia Rm No 2041, Research & Education Network, Westmead Hospital, Westmead NSW 2145, Australia
| | - Kristian B Filion
- Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, 3755 Côte Ste-Catherine Road, Montreal, Quebec H3T 1E2, Canada.,Department of Medicine McGill University, 1001 Decarie Boulevard, suite D05-2212, Montreal, Quebec H4A 3J1, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 2001 McGill College, Suite 1200, Montreal, Quebec H3A 1G1, Canada
| | - Louisa Jorm
- Centre for Big Data Research in Health, UNSW Sydney, Australia Level 2, G27 Botany Street, Kensington NSW 2052, Australia
| | - Alys Havard
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-42 King Street, Randwick NSW 2031, Australia.,Centre for Big Data Research in Health, UNSW Sydney, Australia Level 2, G27 Botany Street, Kensington NSW 2052, Australia
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Park SY, Kim YC, Lee R, Kim B, Moon SM, Kim HB. Current Status and Prospect of Qualitative Assessment of Antibiotics Prescriptions. Infect Chemother 2022; 54:599-609. [PMID: 36596676 PMCID: PMC9840950 DOI: 10.3947/ic.2022.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022] Open
Abstract
Identifying inappropriately prescribed antibiotics for infectious diseases by monitoring the quality of antibiotics use is essential for effective implementation of antibiotic stewardship. Qualitative assessment of the use of antibiotics has been conducted in some countries, including Korea, since the 2000s. The qualitative assessment generally involves an assessment of each component of the antibiotics prescription process, based on specific criteria. However, there is no standardized assessment method or cycle, and infectious diseases or antibiotics included in the assessments vary from country-to-country. According to the results reported in the United States, Europe, Australia, and Korea so far, approximately 20 - 55% of all antibiotics prescriptions are inappropriate. In this review, we describe the current progress in the quality assessment of the use of antibiotics on a global scale. Further, we highlight the future directions to improve antibiotic stewardship activities and the quality assessment of the use of antibiotics in Korea.
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Affiliation(s)
- Se Yoon Park
- Department of Hospital Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea.,Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea.,Centers for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
| | - Yong Chan Kim
- Department of Internal Medicine, Division of Infectious diseases, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Raeseok Lee
- Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Song Mi Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Abstract
An opioid epidemic has been happening across the world since the 1990s and continues impact individuals, families, communities and societies around the globe. The epidemic has evolved from heroin misuse to the use of synthetic opioids that are easily manufactured and are readily available. Reasons for the continuing opioid epidemic are complex, and include factors related to mental health, addiction, chronic pain relief, and, now, the COVID-19 pandemic. Women have been disproportionally affected by the opioid epidemic and the physical and biosocial effects of opioid use specific to women are an important consideration for healthcare providers. Recent data show that the effects of the opioid epidemic on rates of opioid use disorder (OUD), overdoses, and the economy continue to rise, despite global efforts to understand the drivers and develop effective prevention and intervention strategies, programs, and policies.
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Affiliation(s)
- Jocelynn L Cook
- The Society of Obstetricians and Gynaecologists of Canada and the Department of Obstetrics, Gynaecology and Newborn Care, The University of Ottawa, 2781 Lancaster Rd, Suite 200, Ottawa, ON K1B 1A7, Canada.
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47
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Wright N, Ramirez MR, Southwell B, Hemmila M, Napolitano L, Tignanelli CJ. A serial cross-sectional study of trends and predictors of prescription controlled substance-related traumatic injury. Prev Med 2022; 164:107275. [PMID: 36156284 DOI: 10.1016/j.ypmed.2022.107275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/12/2022] [Accepted: 09/18/2022] [Indexed: 11/20/2022]
Abstract
Pre-injury drug use is a key contributor to traumatic injury. However, limited research has examined trends and predictors of controlled substance-related trauma. The present study aims to provide better clarity on the specific role of prescription-controlled substances (PCS) in traumatic injury events. The data source was the American College of Surgeons National Trauma Data Bank. Trends by injury mechanism and intent for patients with PCS and no-confirmed substances were compared from 2007 to 2014. Logistic regression models were also performed to examine the association between substance use and injury mechanism and intent for data across the study period. Of 405,334 trauma patients, 328,623 (81.1%) had no-confirmed substances and 76,711 (18.9%) had PCS detected. The majority of events in the PCS and no-confirmed substance groups were classified as unintentional. Motor vehicle traffic (MVT), falls, other transport, and cut/pierce injuries accounted for approximately 80% of all injuries. From 2007 to 2014, the proportion of injuries with PCS increased for all injury mechanisms and injury intents. The injury mechanisms of fire/burn, firearm, machinery, poisoning, and other transport were significantly more likely to have PCS relative to MVT injuries. For injury intent, self-harm was more likely to have a toxicology test positive for PCS, while assault was less likely to have a toxicology test positive for PCS compared to unintentional injuries. PCS-related traumatic injuries increased significantly over time and across injury mechanisms and intents. These findings can be used to inform prescribing and understand risk factors to reduce the likelihood of PCS-related traumatic injury.
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Ssegonja R, Alaie I, Holmgren A, Bohman H, Päären A, von Knorring L, von Knorring AL, Jonsson U. Association of adolescent depression with subsequent prescriptions of anti-infectives and anti-inflammatories in adulthood: A longitudinal cohort study. Psychiatry Res 2022; 317:114813. [PMID: 36058038 DOI: 10.1016/j.psychres.2022.114813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 10/31/2022]
Abstract
New insights into how depression is linked to physical health throughout the lifespan could potentially inform clinical decision making. The aim of this study was to explore the association of adolescent depression with subsequent prescriptions of anti-infectives and anti-inflammatories in adulthood. The study was based on the Uppsala Longitudinal Adolescent Depression Study (ULADS), a Swedish prospective cohort study initiated in 1991. Depressed (n = 321) and non-depressed (n = 218) adolescents were followed prospectively using patient registries. The associations of adolescent depression (age 16-17 years) with subsequent prescription of anti-infectives and anti-inflammatories (age 30-40 years), were analysed using generalized linear models. Sub-analyses explored the impact of diagnostic characteristics in adolescence and reception of anti-depressants prescriptions in adulthood. The results suggest that females with persistent depressive disorder in adolescence have a higher rate of future prescriptions than non-depressed peers, with adjusted incidence rate ratio of 1.42 (1.06 to 1.92) for anti-infectives and 1.72 (1.10 to 2.70) for anti-inflammatories. These associations were mainly driven by those who were also prescribed antidepressants during the same period. Associations were less robust for females with episodic or subsyndromal depression in adolescence and for males. These findings emphasize the importance of integrated mental health services at the primary healthcare level.
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Affiliation(s)
- Richard Ssegonja
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Respiratory, Allergy- and Sleep Medicine Research Unit, Uppsala University, Uppsala, Sweden.
| | - Iman Alaie
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Amanda Holmgren
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Hannes Bohman
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Aivar Päären
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Lars von Knorring
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Anne-Liis von Knorring
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Ulf Jonsson
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden; Centre of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden; Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Haggerty T, Sedney CL, Dekeseredy P, Nwafor D, Brownstein HH, Caretta MA, Pollini RA. Pain Management During West Virginia's Opioid Crisis. J Am Board Fam Med 2022; 35:940-50. [PMID: 36257694 DOI: 10.3122/jabfm.2022.05.220097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/17/2022] [Accepted: 05/23/2022] [Indexed: 03/21/2023] Open
Abstract
PURPOSE Opioid use disorder has caused significant morbidity and mortality resulting in opioid prescribing limiting laws, such as State Bill 273 in West Virginia. The purpose of this study is to explore the impacts of a restrictive opioid prescription law on physicians in medical practice in West Virginia. METHODS A qualitative study with open-ended semistructured interviews with a purposive sample of physicians in West Virginia. Interviews were recorded and transcribed verbatim. A preliminary code book was developed by 3 coinvestigators. Interview transcriptions were analyzed with a code-based text search query. Content analysis was utilized as the methodological orientation underpinning for the current work. RESULTS Interviews were conducted with 20 physicians (10 primary care physicians and 10 specialty physicians) in practice in West Virginia. Physicians identified 5 theoretical domains related to SB273: changing opioid prescribing and documentation requirements; rural socioeconomic disparities; a continuum between chronic pain and substance use disorder; difficulty in balancing patient needs and the concern for diversion; lack of available alternatives to opioids for chronic. CONCLUSION Prescribing opioids in rural West Virginia is complex due to identified challenges. Recommendations for opioids prescribing legislation include clear messaging of guidelines and recommendations, efforts to address socioeconomic disparities of health and pain, and improved accessibility for treatment of both pain and dependence in rural communities are important areas of growth in the rural health care environment.
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Glavind AS, Kruse AB, Nielsen LR, Stege H. Monitoring antimicrobial usage in companion animals: exploring the use of the Danish VetStat database. Acta Vet Scand 2022; 64:27. [PMID: 36253805 PMCID: PMC9575193 DOI: 10.1186/s13028-022-00647-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the Danish Veterinary Statistics Program, VetStat, sales data on medicinal products prescribed for veterinary consumption is collected. The Danish Food and Veterinary Administration (DVFA) manages the database and each purchase contains detailed product-specific information linked with a species-specific ID. National surveillance systems are also implemented or being developed in the other European Union Member States. By 2029, all Member States are required to report data on antimicrobial usage for companion animals to the European Medicines Agency. This study aimed to assess the challenges encountered when using the VetStat database to quantify antimicrobial use in Danish companion animals. Raw VetStat data were propagated by the DVFA and originated from veterinary practitioners and Danish pharmacies. RESULTS Comprehensive estimates of antimicrobial use in Danish companion animals were not readily available due to database construct. Antimicrobials sold for use in companion animals (linked to a companion animal ID) comprised a large number of products licensed solely for horses or livestock, while data assigned a replacement code encompassed both topical and peroral antimicrobials licensed for companion animals. Additionally, antimicrobials sold from pharmacies to veterinary practitioners presented the biggest challenge in data retrieval and validation. Treatment data are only transferred to VetStat through the billing systems when Danish veterinarians are treating livestock, but not companion animals. Information on products sold for in-house use in companion animals is only available from pharmacy records without a species-specific ID. As a result, parenteral antimicrobials with multi-species authorization utilized by small animal veterinary practitioners are not accounted for in the overall estimate for companion animals. CONCLUSIONS Owing to the database structure and requirements for data entry, antimicrobial use in companion animals is an approximation. The actual consumption may be significantly higher than what is currently calculated from the database, as the majority of parenteral products are not included. Consumption data can be measured more accurately provided treatment data from veterinary practitioners in small or mixed practices are transferred to the database through the billing system. This would equal the legal requirements for Danish veterinary practitioners treating livestock.
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Affiliation(s)
- Anne-Sofie Glavind
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Groennegaardsvej 3, 1870, Frederiksberg C, Denmark.
| | - Amanda Brinch Kruse
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Groennegaardsvej 3, 1870, Frederiksberg C, Denmark
| | - Liza Rosenbaum Nielsen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Groennegaardsvej 3, 1870, Frederiksberg C, Denmark
| | - Helle Stege
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Groennegaardsvej 3, 1870, Frederiksberg C, Denmark
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